Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No

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Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00002081702 AVENTYL HCL 10 MG PULVULE 46059 NORTRIPTYLINE HCL ELI LILLY AND COMPANY 00002081703 AVENTYL HCL 10 MG PULVULE 46059 NORTRIPTYLINE HCL ELI LILLY AND COMPANY 00002081733 AVENTYL HCL 10MG PULVULE 46059 NORTRIPTYLINE HCL ELI LILLY AND COMPANY 00002081902 AVENTYL HCL 25 MG PULVULE 46060 NORTRIPTYLINE HCL ELI LILLY AND COMPANY 00002081903 AVENTYL HCL 25 MG PULVULE 46060 NORTRIPTYLINE HCL ELI LILLY AND COMPANY 00002081933 AVENTYL HCL 25MG PULVULE 46060 NORTRIPTYLINE HCL ELI LILLY AND COMPANY 00002246805 AVENTYL 10 MG/5 ML SOLUTION 46063 NORTRIPTYLINE HCL ELI LILLY AND COMPANY 00002300475 PROZAC WEEKLY 90 MG CAPSULE 47571 FLUOXETINE HCL ELI LILLY AND COMPANY 00002321045 SARAFEM 10 MG PULVULE 46213 FLUOXETINE HCL ELI LILLY AND COMPANY 00002322045 SARAFEM 20 MG PULVULE 46214 FLUOXETINE HCL ELI LILLY AND COMPANY 00002322730 STRATTERA 10 MG CAPSULE 51489 ATOMOXETINE HCL ELI LILLY AND COMPANY 00002322830 STRATTERA 25 MG CAPSULE 51491 ATOMOXETINE HCL ELI LILLY AND COMPANY 00002322930 STRATTERA 40 MG CAPSULE 51492 ATOMOXETINE HCL ELI LILLY AND COMPANY 00002323030 SYMBYAX 3-25 MG CAPSULE 62878 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323101 SYMBYAX 6-25 MG CAPSULE 53400 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323130 SYMBYAX 6-25 MG CAPSULE 53400 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323133 SYMBYAX 6-25 MG CAPSULE 53400 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323201 SYMBYAX 12-25 MG CAPSULE 53402 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323230 SYMBYAX 12-25 MG CAPSULE 53402 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323233 SYMBYAX 12-25 MG CAPSULE 53402 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323301 SYMBYAX 6-50 MG CAPSULE 53401 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323330 SYMBYAX 6-50 MG CAPSULE 53401 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323333 SYMBYAX 6-50 MG CAPSULE 53401 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323401 SYMBYAX 12-50 MG CAPSULE 53403 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323430 SYMBYAX 12-50 MG CAPSULE 53403 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323433 SYMBYAX 12-50 MG CAPSULE 53403 OLANZAPINE/FLUOXETINE HCL ELI LILLY AND COMPANY 00002323560 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL ELI LILLY AND COMPANY 00002323701 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002323704 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002323730 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002323733 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002323734 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002323830 STRATTERA 18 MG CAPSULE 51490 ATOMOXETINE HCL ELI LILLY AND COMPANY 00002323930 STRATTERA 60 MG CAPSULE 51493 ATOMOXETINE HCL ELI LILLY AND COMPANY 00002324001 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL ELI LILLY AND COMPANY 00002324030 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL ELI LILLY AND COMPANY 00002324033 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL ELI LILLY AND COMPANY 00002324090 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL ELI LILLY AND COMPANY 00002325030 STRATTERA 80 MG CAPSULE 60390 ATOMOXETINE HCL ELI LILLY AND COMPANY

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 1 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00002325130 STRATTERA 100 MG CAPSULE 60391 ATOMOXETINE HCL ELI LILLY AND COMPANY 00002327001 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002327004 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002327030 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002327033 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ELI LILLY AND COMPANY 00002400602 PROZAC 10 MG TABLET 46216 FLUOXETINE HCL ELI LILLY AND COMPANY 00002400630 PROZAC 10 MG TABLET 46216 FLUOXETINE HCL ELI LILLY AND COMPANY 00002411201 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE ELI LILLY AND COMPANY 00002411204 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE ELI LILLY AND COMPANY 00002411230 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE ELI LILLY AND COMPANY 00002411233 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE ELI LILLY AND COMPANY 00002411260 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE ELI LILLY AND COMPANY 00002411501 ZYPREXA 5 MG TABLET 27961 OLANZAPINE ELI LILLY AND COMPANY 00002411504 ZYPREXA 5 MG TABLET 27961 OLANZAPINE ELI LILLY AND COMPANY 00002411530 ZYPREXA 5 MG TABLET 27961 OLANZAPINE ELI LILLY AND COMPANY 00002411533 ZYPREXA 5 MG TABLET 27961 OLANZAPINE ELI LILLY AND COMPANY 00002411560 ZYPREXA 5 MG TABLET 27961 OLANZAPINE ELI LILLY AND COMPANY 00002411601 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE ELI LILLY AND COMPANY 00002411604 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE ELI LILLY AND COMPANY 00002411630 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE ELI LILLY AND COMPANY 00002411633 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE ELI LILLY AND COMPANY 00002411660 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE ELI LILLY AND COMPANY 00002411701 ZYPREXA 10 MG TABLET 27960 OLANZAPINE ELI LILLY AND COMPANY 00002411704 ZYPREXA 10 MG TABLET 27960 OLANZAPINE ELI LILLY AND COMPANY 00002411730 ZYPREXA 10 MG TABLET 27960 OLANZAPINE ELI LILLY AND COMPANY 00002411733 ZYPREXA 10 MG TABLET 27960 OLANZAPINE ELI LILLY AND COMPANY 00002411760 ZYPREXA 10 MG TABLET 27960 OLANZAPINE ELI LILLY AND COMPANY 00002441501 ZYPREXA 15 MG TABLET 41026 OLANZAPINE ELI LILLY AND COMPANY 00002441504 ZYPREXA 15 MG TABLET 41026 OLANZAPINE ELI LILLY AND COMPANY 00002441530 ZYPREXA 15 MG TABLET 41026 OLANZAPINE ELI LILLY AND COMPANY 00002441533 ZYPREXA 15 MG TABLET 41026 OLANZAPINE ELI LILLY AND COMPANY 00002441560 ZYPREXA 15 MG TABLET 41026 OLANZAPINE ELI LILLY AND COMPANY 00002442001 ZYPREXA 20 MG TABLET 41027 OLANZAPINE ELI LILLY AND COMPANY 00002442004 ZYPREXA 20 MG TABLET 41027 OLANZAPINE ELI LILLY AND COMPANY 00002442030 ZYPREXA 20 MG TABLET 41027 OLANZAPINE ELI LILLY AND COMPANY 00002442033 ZYPREXA 20 MG TABLET 41027 OLANZAPINE ELI LILLY AND COMPANY 00002442060 ZYPREXA 20 MG TABLET 41027 OLANZAPINE ELI LILLY AND COMPANY 00002445301 ZYPREXA ZYDIS 5 MG TABLET 45190 OLANZAPINE ELI LILLY AND COMPANY 00002445385 ZYPREXA ZYDIS 5 MG TABLET 45190 OLANZAPINE ELI LILLY AND COMPANY

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 2 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00002445401 ZYPREXA ZYDIS 10 MG TABLET 45191 OLANZAPINE ELI LILLY AND COMPANY 00002445485 ZYPREXA ZYDIS 10 MG TABLET 45191 OLANZAPINE ELI LILLY AND COMPANY 00002445501 ZYPREXA ZYDIS 15 MG TABLET 47285 OLANZAPINE ELI LILLY AND COMPANY 00002445585 ZYPREXA ZYDIS 15 MG TABLET 47285 OLANZAPINE ELI LILLY AND COMPANY 00002445601 ZYPREXA ZYDIS 20 MG TABLET 47286 OLANZAPINE ELI LILLY AND COMPANY 00002445685 ZYPREXA ZYDIS 20 MG TABLET 47286 OLANZAPINE ELI LILLY AND COMPANY 00002759701 ZYPREXA 10 MG VIAL 50386 OLANZAPINE ELI LILLY AND COMPANY 00002763511 ZYPREXA RELPREVV 210 MG VIAL 65795 OLANZAPINE PAMOATE ELI LILLY AND COMPANY 00002763611 ZYPREXA RELPREVV 300 MG VIAL 65794 OLANZAPINE PAMOATE ELI LILLY AND COMPANY 00002763711 ZYPREXA RELPREVV 405 MG VIAL 65793 OLANZAPINE PAMOATE ELI LILLY AND COMPANY 00003056902 PROLIXIN DECANOATE 25 MG/ML 3817 FLUPHENAZINE DECANOATE E.R. SQUIBB & SONS, INC. 00003056915 PROLIXIN DECANOATE 25 MG/ML 3818 FLUPHENAZINE DECANOATE E.R. SQUIBB & SONS, INC. 00003058630 PROLIXIN 2.5MG/ML VIAL 3820 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003080110 PROLIXIN 5 MG/ML ORAL CONC 3822 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003082030 PROLIXIN 2.5 MG/5 ML ELIXIR 3821 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003082050 PROLIXIN 2.5MG/5ML ELIXIR 3821 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003082405 PROLIXIN ENANTHATE 25MG/ML 3819 FLUPHENAZINE ENANTHATE E.R. SQUIBB & SONS, INC. 00003086350 PROLIXIN 1MG TABLET 3823 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003086450 PROLIXIN 2.5MG TABLET 3825 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003087750 PROLIXIN 5 MG TABLET 3826 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003087752 PROLIXIN 5MG TABLET 3826 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003092020 VESPRIN 20MG/ML VIAL 3812 TRIFLUPROMAZINE HCL E.R. SQUIBB & SONS, INC. 00003095650 PROLIXIN 10 MG TABLET 3824 FLUPHENAZINE HCL E.R. SQUIBB & SONS, INC. 00003098770 VESPRIN 10MG/ML VIAL 3811 TRIFLUPROMAZINE HCL E.R. SQUIBB & SONS, INC. 00004003201 MARPLAN 10MG TABLET 46262 ISOCARBOXAZID HOFFMANN-LA ROCHE 00004014001 VALRELEASE 15MG CAPSULE 3760 DIAZEPAM HOFFMANN-LA ROCHE 00004014064 VALRELEASE 15MG CAPSULE 3760 DIAZEPAM HOFFMANN-LA ROCHE 00004193209 VALIUM 5MG/ML VIAL 3763 DIAZEPAM HOFFMANN-LA ROCHE 00004193306 VALIUM 5 MG/ML SYRINGE 3762 DIAZEPAM HOFFMANN-LA ROCHE 00005312823 DIAZEPAM 2MG TABLET 3767 DIAZEPAM LEDERLE LABORATORIES 00005312831 DIAZEPAM 2MG TABLET 3767 DIAZEPAM LEDERLE LABORATORIES 00005312923 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LEDERLE LABORATORIES 00005312931 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LEDERLE LABORATORIES 00005313023 DIAZEPAM 10MG TABLET 3766 DIAZEPAM LEDERLE LABORATORIES 00005313031 DIAZEPAM 10MG TABLET 3766 DIAZEPAM LEDERLE LABORATORIES 00005334031 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM LEDERLE LABORATORIES 00005334043 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM LEDERLE LABORATORIES 00005334131 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM LEDERLE LABORATORIES 00005334143 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM LEDERLE LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 3 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00005334231 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM LEDERLE LABORATORIES 00005334243 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM LEDERLE LABORATORIES 00005334643 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM LEDERLE LABORATORIES 00005497002 CENTRUM ST.JOHN'S 300MG CAP 46333 ST. JOHN'S WORT LEDERLE LABORATORIES 00005535960 LOXITANE 5MG CAPSULE 3983 LOXAPINE SUCCINATE LEDERLE LABORATORIES 00005536060 LOXITANE 10MG CAPSULE 3981 LOXAPINE SUCCINATE LEDERLE LABORATORIES 00005536160 LOXITANE 25MG CAPSULE 3982 LOXAPINE SUCCINATE LEDERLE LABORATORIES 00005536260 LOXITANE 50MG CAPSULE 3984 LOXAPINE SUCCINATE LEDERLE LABORATORIES 00005539160 ASENDIN 100MG TABLET 46081 AMOXAPINE LEDERLE LABORATORIES 00005539238 ASENDIN 150MG TABLET 46082 AMOXAPINE LEDERLE LABORATORIES 00006002668 VIVACTIL 5MG TABLET 46080 PROTRIPTYLINE HCL MERCK & CO., INC. 00006004728 VIVACTIL 10MG TABLET 46079 PROTRIPTYLINE HCL MERCK & CO., INC. 00006004768 VIVACTIL 10MG TABLET 46079 PROTRIPTYLINE HCL MERCK & CO., INC. 00006051760 TRIAVIL 4-50 TABLET 46188 PERPHENAZINE/AMITRIPTYLINE HCLMERCK & CO., INC. 00006051768 TRIAVIL 4-50 TABLET 46188 PERPHENAZINE/AMITRIPTYLINE HCLMERCK & CO., INC. 00007400720 ESKALITH 300 MG CAPSULE 4001 LITHIUM CARBONATE GLAXOSMITHKLINE 00007400725 ESKALITH 300 MG CAPSULE 4001 LITHIUM CARBONATE GLAXOSMITHKLINE 00007401020 ESKALITH CR 450 MG TABLET SA 4005 LITHIUM CARBONATE GLAXOSMITHKLINE 00007447120 PARNATE 10 MG TABLET 46264 TRANYLCYPROMINE SULFATE GLAXOSMITHKLINE 00007504744 THORAZINE 30MG/ML LIQ CONC 3795 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007504948 THORAZINE 100MG/ML LIQ CONC 3794 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007506011 THORAZINE 25MG/ML AMPUL 3788 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007506101 THORAZINE 25MG/ML AMPUL 3788 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007506111 THORAZINE 25MG/ML AMPUL 3788 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007506201 THORAZINE 25 MG/ML VIAL 3790 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007506315 THORAZINE SPANSULE 30MG 3785 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007506415 THORAZINE SPANSULE 75MG 3787 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007506615 THORAZINE SPANSULE 150MG 3783 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507003 THORAZINE 25MG SUPPOSITORY 3792 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507103 THORAZINE 100 MG SUPPOSITORY 3791 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507244 THORAZINE 10MG/5ML SYRUP 3793 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507320 THORAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507420 THORAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507430 THORAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507620 THORAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507630 THORAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507720 THORAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507730 THORAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00007507920 THORAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL GLAXOSMITHKLINE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 4 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00007507930 THORAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL GLAXOSMITHKLINE 00008000105 EQUANIL 400MG TABLET 3714 MEPROBAMATE WYETH LABORATORIES 00008000107 EQUANIL 400MG TABLET 3714 MEPROBAMATE WYETH LABORATORIES 00008000203 EQUANIL 200MG TABLET 3713 MEPROBAMATE WYETH LABORATORIES 00008000601 SERAX 15MG CAPSULE 3770 OXAZEPAM WYETH LABORATORIES 00008000602 SERAX 15MG CAPSULE 3770 OXAZEPAM WYETH LABORATORIES 00008000604 SERAX 15MG CAPSULE 3770 OXAZEPAM WYETH LABORATORIES 00008002801 SPARINE 50MG TABLET 3810 PROMAZINE HCL WYETH LABORATORIES 00008002901 SPARINE 25MG TABLET 3809 PROMAZINE HCL WYETH LABORATORIES 00008004001 SPARINE 50MG/ML VIAL 3804 PROMAZINE HCL WYETH LABORATORIES 00008004002 SPARINE 50MG/ML VIAL 3804 PROMAZINE HCL WYETH LABORATORIES 00008005102 SERAX 10MG CAPSULE 3769 OXAZEPAM WYETH LABORATORIES 00008005103 SERAX 10MG CAPSULE 3769 OXAZEPAM WYETH LABORATORIES 00008005201 SERAX 30MG CAPSULE 3771 OXAZEPAM WYETH LABORATORIES 00008005202 SERAX 30MG CAPSULE 3771 OXAZEPAM WYETH LABORATORIES 00008005204 SERAX 30MG CAPSULE 3771 OXAZEPAM WYETH LABORATORIES 00008006402 ATIVAN 1 MG TABLET 3758 LORAZEPAM WYETH LABORATORIES 00008006403 ATIVAN 1MG TABLET 3758 LORAZEPAM WYETH LABORATORIES 00008006405 ATIVAN 1 MG TABLET 3758 LORAZEPAM WYETH LABORATORIES 00008006409 ATIVAN 1MG TABLET 3758 LORAZEPAM WYETH LABORATORIES 00008006502 ATIVAN 2 MG TABLET 3759 LORAZEPAM WYETH LABORATORIES 00008006503 ATIVAN 2MG TABLET 3759 LORAZEPAM WYETH LABORATORIES 00008006505 ATIVAN 2MG TABLET 3759 LORAZEPAM WYETH LABORATORIES 00008008102 ATIVAN 0.5 MG TABLET 3757 LORAZEPAM WYETH LABORATORIES 00008008103 ATIVAN 0.5MG TABLET 3757 LORAZEPAM WYETH LABORATORIES 00008031701 SERAX 15MG TABLET 3772 OXAZEPAM WYETH LABORATORIES 00008070101 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL WYETH LABORATORIES 00008070102 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL WYETH LABORATORIES 00008070107 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL WYETH LABORATORIES 00008070108 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL WYETH LABORATORIES 00008070301 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL WYETH LABORATORIES 00008070302 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL WYETH LABORATORIES 00008070307 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL WYETH LABORATORIES 00008070308 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL WYETH LABORATORIES 00008070401 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL WYETH LABORATORIES 00008070402 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL WYETH LABORATORIES 00008070407 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL WYETH LABORATORIES 00008070408 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL WYETH LABORATORIES 00008070501 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL WYETH LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 5 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00008070502 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL WYETH LABORATORIES 00008070507 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL WYETH LABORATORIES 00008070508 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL WYETH LABORATORIES 00008078101 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL WYETH LABORATORIES 00008078102 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL WYETH LABORATORIES 00008078107 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL WYETH LABORATORIES 00008078108 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL WYETH LABORATORIES 00008083301 EFFEXOR XR 75 MG CAPSULE SA 46404 VENLAFAXINE HCL WYETH LABORATORIES 00008083302 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL WYETH LABORATORIES 00008083303 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL WYETH LABORATORIES 00008083320 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL WYETH LABORATORIES 00008083321 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL WYETH LABORATORIES 00008083322 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL WYETH LABORATORIES 00008083601 EFFEXOR XR 150 MG CAPSULE SA 46405 VENLAFAXINE HCL WYETH LABORATORIES 00008083602 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL WYETH LABORATORIES 00008083603 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL WYETH LABORATORIES 00008083620 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL WYETH LABORATORIES 00008083621 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL WYETH LABORATORIES 00008083622 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL WYETH LABORATORIES 00008083701 EFFEXOR XR 37.5 MG CAP SA 46403 VENLAFAXINE HCL WYETH LABORATORIES 00008083702 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL WYETH LABORATORIES 00008083703 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL WYETH LABORATORIES 00008083720 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL WYETH LABORATORIES 00008083721 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL WYETH LABORATORIES 00008083722 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL WYETH LABORATORIES 00008121101 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008121114 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008121130 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008121150 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008122201 PRISTIQ ER 100 MG TABLET 63737 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008122214 PRISTIQ ER 100 MG TABLET 63737 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008122230 PRISTIQ ER 100 MG TABLET 63737 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008122250 PRISTIQ ER 100 MG TABLET 63737 DESVENLAFAXINE SUCCINATE WYETH LABORATORIES 00008413201 SURMONTIL 25MG CAPSULE 46112 TRIMIPRAMINE MALEATE WYETH LABORATORIES 00008413301 SURMONTIL 50MG CAPSULE 46113 TRIMIPRAMINE MALEATE WYETH LABORATORIES 00008415801 SURMONTIL 100MG CAPSULE 46111 TRIMIPRAMINE MALEATE WYETH LABORATORIES 00009002901 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PFIZER, INC 00009002902 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PFIZER, INC 00009002914 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PFIZER, INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 6 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00009002946 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PFIZER, INC 00009005501 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PFIZER, INC 00009005503 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PFIZER, INC 00009005515 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PFIZER, INC 00009005546 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PFIZER, INC 00009005707 XANAX XR 0.5 MG TABLET 50399 ALPRAZOLAM PFIZER, INC 00009005907 XANAX XR 1 MG TABLET 50400 ALPRAZOLAM PFIZER, INC 00009006607 XANAX XR 2 MG TABLET 50401 ALPRAZOLAM PFIZER, INC 00009006807 XANAX XR 3 MG TABLET 52143 ALPRAZOLAM PFIZER, INC 00009009001 XANAX 1 MG TABLET 3775 ALPRAZOLAM PFIZER, INC 00009009004 XANAX 1 MG TABLET 3775 ALPRAZOLAM PFIZER, INC 00009009013 XANAX 1 MG TABLET 3775 ALPRAZOLAM PFIZER, INC 00009009017 XANAX 1MG TABLET 3775 ALPRAZOLAM PFIZER, INC 00009009046 XANAX 1MG TABLET 3775 ALPRAZOLAM PFIZER, INC 00009009401 XANAX 2 MG TABLET 15566 ALPRAZOLAM PFIZER, INC 00009009403 XANAX 2 MG TABLET 15566 ALPRAZOLAM PFIZER, INC 00024037602 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM SANOFI-AVENTIS, US LLC 00024037620 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM SANOFI-AVENTIS, US LLC 00024197304 TRANCOPAL 100MG CAPLET 3717 CHLORMEZANONE SANOFI-AVENTIS, US LLC 00024197404 TRANCOPAL 200MG CAPLET 3718 CHLORMEZANONE SANOFI-AVENTIS, US LLC 00024581030 APLENZIN ER 174 MG TABLET 65345 BUPROPION HBR SANOFI-AVENTIS, US LLC 00024581130 APLENZIN ER 348 MG TABLET 64896 BUPROPION HBR SANOFI-AVENTIS, US LLC 00024581230 APLENZIN ER 522 MG TABLET 64899 BUPROPION HBR SANOFI-AVENTIS, US LLC 00028002001 TOFRANIL-PM 75MG CAPSULE 46078 IMIPRAMINE PAMOATE NOVARTIS 00028002026 TOFRANIL-PM 75MG CAPSULE 46078 IMIPRAMINE PAMOATE NOVARTIS 00028002201 TOFRANIL-PM 150MG CAPSULE 46077 IMIPRAMINE PAMOATE NOVARTIS 00028002226 TOFRANIL-PM 150MG CAPSULE 46077 IMIPRAMINE PAMOATE NOVARTIS 00028003201 TOFRANIL 10 MG TABLET 46068 IMIPRAMINE HCL NOVARTIS 00028004001 TOFRANIL-PM 100MG CAPSULE 46075 IMIPRAMINE PAMOATE NOVARTIS 00028004026 TOFRANIL-PM 100MG CAPSULE 46075 IMIPRAMINE PAMOATE NOVARTIS 00028004501 TOFRANIL-PM 125MG CAPSULE 46076 IMIPRAMINE PAMOATE NOVARTIS 00028004526 TOFRANIL-PM 125MG CAPSULE 46076 IMIPRAMINE PAMOATE NOVARTIS 00028013601 TOFRANIL 50 MG TABLET 46070 IMIPRAMINE HCL NOVARTIS 00028014001 TOFRANIL 25MG TABLET 46069 IMIPRAMINE HCL NOVARTIS 00028014065 TOFRANIL 25MG TABLET 46069 IMIPRAMINE HCL NOVARTIS 00029320613 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL GLAXOSMITHKLINE 00029320713 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL GLAXOSMITHKLINE 00029320813 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL GLAXOSMITHKLINE 00029321013 PAXIL 10 MG TABLET 46222 PAROXETINE HCL GLAXOSMITHKLINE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 7 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00029321113 PAXIL 20 MG TABLET 46223 PAROXETINE HCL GLAXOSMITHKLINE 00029321120 PAXIL 20 MG TABLET 46223 PAROXETINE HCL GLAXOSMITHKLINE 00029321121 PAXIL 20 MG TABLET 46223 PAROXETINE HCL GLAXOSMITHKLINE 00029321159 PAXIL 20 MG TABLET 46223 PAROXETINE HCL GLAXOSMITHKLINE 00029321213 PAXIL 30 MG TABLET 46224 PAROXETINE HCL GLAXOSMITHKLINE 00029321313 PAXIL 40 MG TABLET 46225 PAROXETINE HCL GLAXOSMITHKLINE 00029321548 PAXIL 10 MG/5 ML SUSPENSION 46226 PAROXETINE HCL GLAXOSMITHKLINE 00029460613 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL GLAXOSMITHKLINE 00029460713 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL GLAXOSMITHKLINE 00032420201 LUVOX 25MG TABLET 46208 FLUVOXAMINE MALEATE SOLVAY PHARMACEUTICALS, INC. 00032420211 LUVOX 25MG TABLET 46208 FLUVOXAMINE MALEATE SOLVAY PHARMACEUTICALS, INC. 00032420501 LUVOX 50MG TABLET 46209 FLUVOXAMINE MALEATE SOLVAY PHARMACEUTICALS, INC. 00032420511 LUVOX 50MG TABLET 46209 FLUVOXAMINE MALEATE SOLVAY PHARMACEUTICALS, INC. 00032421001 LUVOX 100MG TABLET 46210 FLUVOXAMINE MALEATE SOLVAY PHARMACEUTICALS, INC. 00032421011 LUVOX 100MG TABLET 46210 FLUVOXAMINE MALEATE SOLVAY PHARMACEUTICALS, INC. 00032449201 LITHOBID 300 MG TABLET SA 4004 LITHIUM CARBONATE SOLVAY PHARMACEUTICALS, INC. 00032449210 LITHOBID 300MG TABLET SA 4004 LITHIUM CARBONATE SOLVAY PHARMACEUTICALS, INC. 00032751201 LITHONATE 300MG CAPSULE 4001 LITHIUM CARBONATE SOLVAY PHARMACEUTICALS, INC. 00032751210 LITHONATE 300MG CAPSULE 4001 LITHIUM CARBONATE SOLVAY PHARMACEUTICALS, INC. 00032751601 LITHOTABS 300MG TABLET 4003 LITHIUM CARBONATE SOLVAY PHARMACEUTICALS, INC. 00032751610 LITHOTABS 300MG TABLET 4003 LITHIUM CARBONATE SOLVAY PHARMACEUTICALS, INC. 00032751611 LITHOTABS 300MG TABLET 4003 LITHIUM CARBONATE SOLVAY PHARMACEUTICALS, INC. 00037100101 MILTOWN 400 MG TABLET 3714 MEPROBAMATE MEDA PHARMACEUTICALS, INC. 00037100102 MILTOWN 400 MG TABLET 3714 MEPROBAMATE MEDA PHARMACEUTICALS, INC. 00037100103 MILTOWN 400 MG TABLET 3714 MEPROBAMATE MEDA PHARMACEUTICALS, INC. 00037110101 MILTOWN 200 MG TABLET 3713 MEPROBAMATE MEDA PHARMACEUTICALS, INC. 00038004010 ELAVIL 10MG TABLET 46043 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004034 ELAVIL 10MG TABLET 46043 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004110 ELAVIL 50MG TABLET 46047 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004134 ELAVIL 50MG TABLET 46047 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004210 ELAVIL 75MG TABLET 46048 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004310 ELAVIL 100MG TABLET 46044 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004510 ELAVIL 25MG TABLET 46046 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004534 ELAVIL 25MG TABLET 46046 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004550 ELAVIL 25MG TABLET 46046 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004710 ELAVIL 150MG TABLET 46045 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004730 ELAVIL 150MG TABLET 46045 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00038004910 ELAVIL 10MG/ML VIAL 46042 AMITRIPTYLINE HCL STUART PHARMACEUTICALS 00045024010 HALDOL 0.5MG TABLET 3972 HALOPERIDOL ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 8 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00045024060 HALDOL 0.5MG TABLET 3972 HALOPERIDOL ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045024160 HALDOL 1MG TABLET 3973 HALOPERIDOL ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045024260 HALDOL 2MG TABLET 3975 HALOPERIDOL ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045024560 HALDOL 5MG TABLET 3977 HALOPERIDOL ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045024660 HALDOL 10MG TABLET 3974 HALOPERIDOL ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045024860 HALDOL 20MG TABLET 3976 HALOPERIDOL ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025004 HALDOL 2MG/ML ORAL CONC 3971 HALOPERIDOL LACTATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025015 HALDOL 2MG/ML ORAL CONC 3971 HALOPERIDOL LACTATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025301 HALDOL DECANOATE 50 AMPUL 3966 HALOPERIDOL DECANOATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025303 HALDOL DECANOATE 50 AMPUL 3966 HALOPERIDOL DECANOATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025346 HALDOL DECANOATE 50 VIAL 3967 HALOPERIDOL DECANOATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025414 HALDOL DECANOATE 100 AMPUL 13076 HALOPERIDOL DECANOATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025446 HALDOL DECANOATE 100 VIAL 11876 HALOPERIDOL DECANOATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025501 HALDOL 5 MG/ML AMPUL 3968 HALOPERIDOL LACTATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00045025549 HALDOL 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE ORTHO-MCNEIL-JANSSEN PHARMECEUTICAL, IN 00047031424 AMOXAPINE 25MG TABLET 46083 AMOXAPINE WARNER CHILCOTT LABORATORIES 00047031524 AMOXAPINE 50MG TABLET 46084 AMOXAPINE WARNER CHILCOTT LABORATORIES 00047031624 AMOXAPINE 100MG TABLET 46081 AMOXAPINE WARNER CHILCOTT LABORATORIES 00047031715 AMOXAPINE 150MG TABLET 46082 AMOXAPINE WARNER CHILCOTT LABORATORIES 00047043124 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WARNER CHILCOTT LABORATORIES 00047043130 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WARNER CHILCOTT LABORATORIES 00047043224 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WARNER CHILCOTT LABORATORIES 00047043230 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WARNER CHILCOTT LABORATORIES 00047043324 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WARNER CHILCOTT LABORATORIES 00047043330 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WARNER CHILCOTT LABORATORIES 00047045124 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WARNER CHILCOTT LABORATORIES 00047045130 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WARNER CHILCOTT LABORATORIES 00047045224 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WARNER CHILCOTT LABORATORIES 00047045230 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WARNER CHILCOTT LABORATORIES 00047045324 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM WARNER CHILCOTT LABORATORIES 00047057724 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL WARNER CHILCOTT LABORATORIES 00047057824 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL WARNER CHILCOTT LABORATORIES 00047059424 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WARNER CHILCOTT LABORATORIES 00047059524 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WARNER CHILCOTT LABORATORIES 00047059624 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL WARNER CHILCOTT LABORATORIES 00047062124 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE WARNER CHILCOTT LABORATORIES 00047063224 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE WARNER CHILCOTT LABORATORIES 00047065024 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE WARNER CHILCOTT LABORATORIES 00047065124 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE WARNER CHILCOTT LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 9 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00047066524 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM WARNER CHILCOTT LABORATORIES 00047066724 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM WARNER CHILCOTT LABORATORIES 00047069024 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM WARNER CHILCOTT LABORATORIES 00047069030 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM WARNER CHILCOTT LABORATORIES 00047071624 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL WARNER CHILCOTT LABORATORIES 00047078524 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WARNER CHILCOTT LABORATORIES 00047078530 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WARNER CHILCOTT LABORATORIES 00047078630 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WARNER CHILCOTT LABORATORIES 00047078724 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WARNER CHILCOTT LABORATORIES 00047078730 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WARNER CHILCOTT LABORATORIES 00047079024 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL WARNER CHILCOTT LABORATORIES 00047079124 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL WARNER CHILCOTT LABORATORIES 00047262335 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL WARNER CHILCOTT LABORATORIES 00047291336 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE WARNER CHILCOTT LABORATORIES 00049392083 GEODON 20 MG VIAL 50102 ZIPRASIDONE MESYLATE PFIZER, INC 00049396041 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL PFIZER, INC 00049396060 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL PFIZER, INC 00049397041 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL PFIZER, INC 00049397060 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL PFIZER, INC 00049398041 GEODON 60 MG CAPSULE 47567 ZIPRASIDONE HCL PFIZER, INC 00049398060 GEODON 60 MG CAPSULE 47567 ZIPRASIDONE HCL PFIZER, INC 00049399041 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL PFIZER, INC 00049399060 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL PFIZER, INC 00049490030 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC 00049490041 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC 00049490066 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC 00049490073 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC 00049490094 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC 00049491030 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC 00049491041 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC 00049491066 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC 00049491073 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC 00049491094 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC 00049494023 ZOLOFT 20 MG/ML ORAL CONC 46230 SERTRALINE HCL PFIZER, INC 00049496030 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL PFIZER, INC 00049496050 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL PFIZER, INC 00049510047 SINEQUAN 10 MG/ML ORAL CONC 46092 DOXEPIN HCL PFIZER, INC 00049534066 SINEQUAN 10 MG CAPSULE 46086 DOXEPIN HCL PFIZER, INC 00049534082 SINEQUAN 10MG CAPSULE 46086 DOXEPIN HCL PFIZER, INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 10 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00049535066 SINEQUAN 25 MG CAPSULE 46089 DOXEPIN HCL PFIZER, INC 00049535094 SINEQUAN 25MG CAPSULE 46089 DOXEPIN HCL PFIZER, INC 00049536066 SINEQUAN 50 MG CAPSULE 46090 DOXEPIN HCL PFIZER, INC 00049536094 SINEQUAN 50MG CAPSULE 46090 DOXEPIN HCL PFIZER, INC 00049537050 SINEQUAN 150 MG CAPSULE 46088 DOXEPIN HCL PFIZER, INC 00049538066 SINEQUAN 100 MG CAPSULE 46087 DOXEPIN HCL PFIZER, INC 00049539066 SINEQUAN 75 MG CAPSULE 46091 DOXEPIN HCL PFIZER, INC 00049539082 SINEQUAN 75MG CAPSULE 46091 DOXEPIN HCL PFIZER, INC 00049571066 NAVANE 1MG CAPSULE 3995 THIOTHIXENE PFIZER, INC 00049572066 NAVANE 2 MG CAPSULE 3997 THIOTHIXENE PFIZER, INC 00049572082 NAVANE 2MG CAPSULE 3997 THIOTHIXENE PFIZER, INC 00049573066 NAVANE 5 MG CAPSULE 3999 THIOTHIXENE PFIZER, INC 00049573082 NAVANE 5MG CAPSULE 3999 THIOTHIXENE PFIZER, INC 00049574066 NAVANE 10 MG CAPSULE 3996 THIOTHIXENE PFIZER, INC 00049574082 NAVANE 10MG CAPSULE 3996 THIOTHIXENE PFIZER, INC 00049575047 NAVANE 5MG/ML ORAL CONC 3994 THIOTHIXENE HCL PFIZER, INC 00049576583 NAVANE 10MG VIAL 3992 THIOTHIXENE HCL PFIZER, INC 00049577041 NAVANE 20MG CAPSULE 3998 THIOTHIXENE PFIZER, INC 00049577066 NAVANE 20 MG CAPSULE 3998 THIOTHIXENE PFIZER, INC 00049577073 NAVANE 20MG CAPSULE 3998 THIOTHIXENE PFIZER, INC 00052010530 REMERON 15 MG TABLET 46450 MIRTAZAPINE ORGANON USA INC. 00052010590 REMERON 15 MG TABLET 46450 MIRTAZAPINE ORGANON USA INC. 00052010606 REMERON 15 MG SOLTAB 47453 MIRTAZAPINE ORGANON USA INC. 00052010630 REMERON 15 MG SOLTAB 47453 MIRTAZAPINE ORGANON USA INC. 00052010690 REMERON 15MG SOLTAB 47453 MIRTAZAPINE ORGANON USA INC. 00052010693 REMERON 15 MG SOLTAB 47453 MIRTAZAPINE ORGANON USA INC. 00052010730 REMERON 30 MG TABLET 46451 MIRTAZAPINE ORGANON USA INC. 00052010790 REMERON 30 MG TABLET 46451 MIRTAZAPINE ORGANON USA INC. 00052010806 REMERON 30 MG SOLTAB 47454 MIRTAZAPINE ORGANON USA INC. 00052010830 REMERON 30 MG SOLTAB 47454 MIRTAZAPINE ORGANON USA INC. 00052010890 REMERON 30MG SOLTAB 47454 MIRTAZAPINE ORGANON USA INC. 00052010893 REMERON 30 MG SOLTAB 47454 MIRTAZAPINE ORGANON USA INC. 00052010930 REMERON 45 MG TABLET 46452 MIRTAZAPINE ORGANON USA INC. 00052011006 REMERON 45 MG SOLTAB 47636 MIRTAZAPINE ORGANON USA INC. 00052011030 REMERON 45 MG SOLTAB 47636 MIRTAZAPINE ORGANON USA INC. 00052011090 REMERON 45MG SOLTAB 47636 MIRTAZAPINE ORGANON USA INC. 00052011806 SAPHRIS 5 MG TABLET SUBLINGUAL 65537 ASENAPINE MALEATE ORGANON USA INC. 00052011890 SAPHRIS 5 MG TABLET SUBLINGUAL 65537 ASENAPINE MALEATE ORGANON USA INC. 00052011906 SAPHRIS 10 MG TAB SUBLINGUAL 65538 ASENAPINE MALEATE ORGANON USA INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 11 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00052011990 SAPHRIS 10 MG TAB SUBLINGUAL 65538 ASENAPINE MALEATE ORGANON USA INC. 00052213903 SAPHRIS 5 MG TABLET SUBLINGUAL 65537 ASENAPINE MALEATE ORGANON USA INC. 00052213904 SAPHRIS 5 MG TABLET SUBLINGUAL 65537 ASENAPINE MALEATE ORGANON USA INC. 00052214203 SAPHRIS 10 MG TAB SUBLINGUAL 65538 ASENAPINE MALEATE ORGANON USA INC. 00052214204 SAPHRIS 10 MG TAB SUBLINGUAL 65538 ASENAPINE MALEATE ORGANON USA INC. 00054002025 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054002125 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054002129 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054002213 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL ROXANE LABORATORIES, INC. 00054002313 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ROXANE LABORATORIES, INC. 00054002328 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ROXANE LABORATORIES, INC. 00054002413 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ROXANE LABORATORIES, INC. 00054002428 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ROXANE LABORATORIES, INC. 00054006258 CITALOPRAM HBR 10 MG/5 ML SOLN 46205 CITALOPRAM HYDROBROMIDE ROXANE LABORATORIES, INC. 00054006344 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE ROXANE LABORATORIES, INC. 00054008246 SERTRALINE 20 MG/ML ORAL CONC 46230 SERTRALINE HCL ROXANE LABORATORIES, INC. 00054021025 PROTRIPTYLINE HCL 5 MG TABLET 46080 PROTRIPTYLINE HCL ROXANE LABORATORIES, INC. 00054021125 PROTRIPTYLINE HCL 10 MG TABLET 46079 PROTRIPTYLINE HCL ROXANE LABORATORIES, INC. 00054022025 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054022031 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054022125 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054022225 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054022321 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054022925 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054022931 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054023025 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE ROXANE LABORATORIES, INC. 00054027313 IMIPRAMINE PAMOATE 75 MG CAP 46078 IMIPRAMINE PAMOATE ROXANE LABORATORIES, INC. 00054027413 IMIPRAMINE PAMOATE 100 MG CAP 46075 IMIPRAMINE PAMOATE ROXANE LABORATORIES, INC. 00054027513 IMIPRAMINE PAMOATE 125 MG CAP 46076 IMIPRAMINE PAMOATE ROXANE LABORATORIES, INC. 00054027613 IMIPRAMINE PAMOATE 150 MG CAP 46077 IMIPRAMINE PAMOATE ROXANE LABORATORIES, INC. 00054252625 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054252725 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054252731 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054253125 LITHIUM CARBONATE 600 MG CAP 4002 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054253131 LITHIUM CARBONATE 600MG CAP 4002 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054306763 ALPRAZOLAM 0.5MG/5ML SOLN 21706 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054306844 ALPRAZOLAM 1 MG/ML ORAL CONC 21523 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054314450 CHLORPROMAZINE 30MG/ML CONC 3795 CHLORPROMAZINE HCL ROXANE LABORATORIES, INC. 00054314658 CHLORPROMAZINE 100 MG/ML CON 3794 CHLORPROMAZINE HCL ROXANE LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 12 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00054318544 DIAZEPAM 5 MG/ML ORAL CONC 3765 DIAZEPAM ROXANE LABORATORIES, INC. 00054318863 DIAZEPAM 5 MG/5 ML SOLUTION 3764 DIAZEPAM ROXANE LABORATORIES, INC. 00054335041 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE ROXANE LABORATORIES, INC. 00054335050 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE ROXANE LABORATORIES, INC. 00054352763 LITHIUM 8 MEQ/5 ML SOLUTION 4006 LITHIUM CITRATE ROXANE LABORATORIES, INC. 00054353244 LORAZEPAM INTENSOL 2 MG/ML 16363 LORAZEPAM ROXANE LABORATORIES, INC. 00054386050 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL ROXANE LABORATORIES, INC. 00054386150 THIORIDAZINE 100 MG/ML CONC 3857 THIORIDAZINE HCL ROXANE LABORATORIES, INC. 00054404125 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL ROXANE LABORATORIES, INC. 00054404225 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL ROXANE LABORATORIES, INC. 00054404325 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ROXANE LABORATORIES, INC. 00054404525 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL ROXANE LABORATORIES, INC. 00054410425 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054410429 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054410525 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054410529 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054410725 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054410729 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054434225 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL ROXANE LABORATORIES, INC. 00054434325 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL ROXANE LABORATORIES, INC. 00054434331 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL ROXANE LABORATORIES, INC. 00054434425 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL ROXANE LABORATORIES, INC. 00054434525 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL ROXANE LABORATORIES, INC. 00054434625 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL ROXANE LABORATORIES, INC. 00054434631 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL ROXANE LABORATORIES, INC. 00054434725 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL ROXANE LABORATORIES, INC. 00054442031 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ROXANE LABORATORIES, INC. 00054452725 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054452731 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054467221 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL ROXANE LABORATORIES, INC. 00054467321 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL ROXANE LABORATORIES, INC. 00054467421 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL ROXANE LABORATORIES, INC. 00054467613 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE ROXANE LABORATORIES, INC. 00054467713 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE ROXANE LABORATORIES, INC. 00054467813 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE ROXANE LABORATORIES, INC. 00054810424 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054810425 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054810524 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054810525 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ROXANE LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 13 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00054810724 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054810725 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ROXANE LABORATORIES, INC. 00054820716 DIAZEPAM 5 MG/5 ML SOLUTION 68715 DIAZEPAM ROXANE LABORATORIES, INC. 00054820816 DIAZEPAM 5 MG/5 ML SOLUTION 3764 DIAZEPAM ROXANE LABORATORIES, INC. 00054834225 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL ROXANE LABORATORIES, INC. 00054834325 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL ROXANE LABORATORIES, INC. 00054834425 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL ROXANE LABORATORIES, INC. 00054834525 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL ROXANE LABORATORIES, INC. 00054834625 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL ROXANE LABORATORIES, INC. 00054834725 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL ROXANE LABORATORIES, INC. 00054841925 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ROXANE LABORATORIES, INC. 00054852625 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054852725 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054852825 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054852904 LITHIUM 8 MEQ/5 ML SOLUTION 4006 LITHIUM CITRATE ROXANE LABORATORIES, INC. 00054853004 LITHIUM CIT 8 MEQ/5 ML SYRUP 4006 LITHIUM CITRATE ROXANE LABORATORIES, INC. 00054853125 LITHIUM CARBONATE 600 MG CAP 4002 LITHIUM CARBONATE ROXANE LABORATORIES, INC. 00054867625 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE ROXANE LABORATORIES, INC. 00054867725 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE ROXANE LABORATORIES, INC. 00056591253 HALOPERIDOL LAC 5MG/ML VIAL 3970 HALOPERIDOL LACTATE DUPONT PHARMACEUTICALS 00068000701 NORPRAMIN 10 MG TABLET 46103 DESIPRAMINE HCL AVENTIS PHARMACEUTICALS 00068001101 NORPRAMIN 25 MG TABLET 46106 DESIPRAMINE HCL AVENTIS PHARMACEUTICALS 00068001501 NORPRAMIN 50 MG TABLET 46107 DESIPRAMINE HCL AVENTIS PHARMACEUTICALS 00068001901 NORPRAMIN 75 MG TABLET 46108 DESIPRAMINE HCL AVENTIS PHARMACEUTICALS 00068002001 NORPRAMIN 100 MG TABLET 46104 DESIPRAMINE HCL AVENTIS PHARMACEUTICALS 00068002150 NORPRAMIN 150 MG TABLET 46105 DESIPRAMINE HCL AVENTIS PHARMACEUTICALS 00069011302 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE PFIZER, INC 00071027024 NARDIL 15MG TABLET 46263 PHENELZINE SULFATE PFIZER, INC 00071035024 NARDIL 15 MG TABLET 46263 PHENELZINE SULFATE PFIZER, INC 00071035060 NARDIL 15 MG TABLET 46263 PHENELZINE SULFATE PFIZER, INC 00071035069 NARDIL 15 MG TABLET 46263 PHENELZINE SULFATE PFIZER, INC 00074118701 DROPERIDOL 2.5 MG/ML AMPUL 3964 DROPERIDOL ABBOTT LABORATORIES 00074127302 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM ABBOTT LABORATORIES 00074127312 DIAZEPAM 5 MG/ML SYRINGE 3762 DIAZEPAM ABBOTT LABORATORIES 00074127322 DIAZEPAM 5 MG/ML SYRINGE 3762 DIAZEPAM ABBOTT LABORATORIES 00074127332 DIAZEPAM 5 MG/ML SYRINGE 3762 DIAZEPAM ABBOTT LABORATORIES 00074156410 DEPACON 500 MG VIAL 31533 VALPROATE SODIUM ABBOTT LABORATORIES 00074226902 DROPERIDOL 2.5MG/ML CARPJT 42086 DROPERIDOL ABBOTT LABORATORIES 00074226911 DROPERIDOL 2.5MG/ML CARPJT 42086 DROPERIDOL ABBOTT LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 14 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00074226932 DROPERIDOL 2.5 MG/ML CARPJT 42086 DROPERIDOL ABBOTT LABORATORIES 00074269913 TRANXENE SD 11.25 MG TAB SA 3747 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074299713 TRANXENE SD 22.5 MG TAB SA 3748 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074321001 DIAZEPAM 5MG/ML AMPUL 3761 DIAZEPAM ABBOTT LABORATORIES 00074321032 DIAZEPAM 5 MG/ML AMPUL 3761 DIAZEPAM ABBOTT LABORATORIES 00074321301 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM ABBOTT LABORATORIES 00074321302 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM ABBOTT LABORATORIES 00074382611 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074382613 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074438911 TRANXENE T-TAB 3.75MG 3745 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074438913 TRANXENE T-TAB 3.75 MG 3745 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074438953 TRANXENE T-TAB 3.75MG 3745 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074439011 TRANXENE T-TAB 7.5MG 3746 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074439013 TRANXENE T-TAB 7.5 MG 3746 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074439053 TRANXENE T-TAB 7.5 MG 3746 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074439111 TRANXENE T-TAB 15MG 3744 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074439113 TRANXENE T-TAB 15 MG 3744 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074439153 TRANXENE T-TAB 15MG 3744 CLORAZEPATE DIPOTASSIUM ABBOTT LABORATORIES 00074568111 DEPAKENE 250MG CAPSULE 4536 VALPROIC ACID ABBOTT LABORATORIES 00074568113 DEPAKENE 250 MG CAPSULE 4536 VALPROIC ACID ABBOTT LABORATORIES 00074568216 DEPAKENE 250 MG/5 ML SOLUTION 4535 VALPROATE SODIUM ABBOTT LABORATORIES 00074611411 DEPAKOTE 125 MG SPRINKLE CAP 4537 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074611413 DEPAKOTE 125 MG SPRINKLE CAP 4537 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621211 DEPAKOTE DR 125 MG TABLET 4538 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621213 DEPAKOTE DR 125 MG TABLET 4538 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621411 DEPAKOTE DR 250 MG TABLET 4539 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621413 DEPAKOTE DR 250 MG TABLET 4539 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621453 DEPAKOTE DR 250 MG TABLET 4539 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621511 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621513 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074621553 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074712611 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074712613 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM ABBOTT LABORATORIES 00074712653 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM ABBOTT LABORATORIES 00078000131 MELLARIL 30 MG/ML ORAL CONC 3858 THIORIDAZINE HCL NOVARTIS 00078000205 MELLARIL 10MG TABLET 3859 THIORIDAZINE HCL NOVARTIS 00078000206 MELLARIL 10MG TABLET 3859 THIORIDAZINE HCL NOVARTIS 00078000209 MELLARIL 10MG TABLET 3859 THIORIDAZINE HCL NOVARTIS 00078000305 MELLARIL 25MG TABLET 3864 THIORIDAZINE HCL NOVARTIS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 15 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00078000306 MELLARIL 25MG TABLET 3864 THIORIDAZINE HCL NOVARTIS 00078000309 MELLARIL 25MG TABLET 3864 THIORIDAZINE HCL NOVARTIS 00078000405 MELLARIL 50MG TABLET 3865 THIORIDAZINE HCL NOVARTIS 00078000406 MELLARIL 50MG TABLET 3865 THIORIDAZINE HCL NOVARTIS 00078000409 MELLARIL 50MG TABLET 3865 THIORIDAZINE HCL NOVARTIS 00078000505 MELLARIL 100 MG TABLET 3860 THIORIDAZINE HCL NOVARTIS 00078000506 MELLARIL 100MG TABLET 3860 THIORIDAZINE HCL NOVARTIS 00078000509 MELLARIL 100MG TABLET 3860 THIORIDAZINE HCL NOVARTIS 00078000605 MELLARIL 150MG TABLET 3862 THIORIDAZINE HCL NOVARTIS 00078000705 MELLARIL 200 MG TABLET 3863 THIORIDAZINE HCL NOVARTIS 00078000706 MELLARIL 200MG TABLET 3863 THIORIDAZINE HCL NOVARTIS 00078000805 MELLARIL 15 MG TABLET 3861 THIORIDAZINE HCL NOVARTIS 00078000931 MELLARIL 100MG/ML ORAL CONC 3857 THIORIDAZINE HCL NOVARTIS 00078001633 PAMELOR 10 MG/5 ML SOLUTION 46063 NORTRIPTYLINE HCL NOVARTIS 00078006833 MELLARIL-S 25MG/5ML SUSP 3856 THIORIDAZINE HCL NOVARTIS 00078006933 MELLARIL-S 100MG/5ML SUSP 3855 THIORIDAZINE HCL NOVARTIS 00078007805 PAMELOR 50MG CAPSULE 46061 NORTRIPTYLINE HCL NOVARTIS 00078007806 PAMELOR 50MG CAPSULE 46061 NORTRIPTYLINE HCL NOVARTIS 00078007905 PAMELOR 75MG CAPSULE 46062 NORTRIPTYLINE HCL NOVARTIS 00078008605 PAMELOR 10MG CAPSULE 46059 NORTRIPTYLINE HCL NOVARTIS 00078008606 PAMELOR 10MG CAPSULE 46059 NORTRIPTYLINE HCL NOVARTIS 00078008705 PAMELOR 25MG CAPSULE 46060 NORTRIPTYLINE HCL NOVARTIS 00078008706 PAMELOR 25MG CAPSULE 46060 NORTRIPTYLINE HCL NOVARTIS 00078008708 PAMELOR 25 MG CAPSULE 46060 NORTRIPTYLINE HCL NOVARTIS 00078012605 CLOZARIL 25 MG TABLET 13648 CLOZAPINE NOVARTIS 00078012606 CLOZARIL 25 MG TABLET 13648 CLOZAPINE NOVARTIS 00078012705 CLOZARIL 100 MG TABLET 13649 CLOZAPINE NOVARTIS 00078012706 CLOZARIL 100 MG TABLET 13649 CLOZAPINE NOVARTIS 00078031605 ANAFRANIL 25MG CAPSULE 46120 CLOMIPRAMINE HCL NOVARTIS 00078031606 ANAFRANIL 25MG CAPSULE 46120 CLOMIPRAMINE HCL NOVARTIS 00078031705 ANAFRANIL 50MG CAPSULE 46121 CLOMIPRAMINE HCL NOVARTIS 00078031706 ANAFRANIL 50MG CAPSULE 46121 CLOMIPRAMINE HCL NOVARTIS 00078031805 ANAFRANIL 75 MG CAPSULE 46122 CLOMIPRAMINE HCL NOVARTIS 00078059520 FANAPT 1 MG TABLET 65901 ILOPERIDONE NOVARTIS 00078059620 FANAPT 2 MG TABLET 65902 ILOPERIDONE NOVARTIS 00078059720 FANAPT 4 MG TABLET 65903 ILOPERIDONE NOVARTIS 00078059820 FANAPT 6 MG TABLET 65904 ILOPERIDONE NOVARTIS 00078059920 FANAPT 8 MG TABLET 65905 ILOPERIDONE NOVARTIS 00078060020 FANAPT 10 MG TABLET 65906 ILOPERIDONE NOVARTIS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 16 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00078060120 FANAPT 12 MG TABLET 65907 ILOPERIDONE NOVARTIS 00078060208 FANAPT TITRATION PACK 65908 ILOPERIDONE NOVARTIS 00081017755 WELLBUTRIN 75MG TABLET 46236 BUPROPION HCL GLAXOSMITHKLINE 00081017855 WELLBUTRIN 100MG TABLET 46237 BUPROPION HCL GLAXOSMITHKLINE 00081063325 LAMICTAL 25MG TABLET 17872 LAMOTRIGINE GLAXOSMITHKLINE 00081064255 LAMICTAL 100MG TABLET 17871 LAMOTRIGINE GLAXOSMITHKLINE 00081064360 LAMICTAL 150MG TABLET 22550 LAMOTRIGINE GLAXOSMITHKLINE 00081064460 LAMICTAL 200MG TABLET 22551 LAMOTRIGINE GLAXOSMITHKLINE 00083002630 LUDIOMIL 50MG TABLET 46133 MAPROTILINE HCL NOVARTIS 00083011030 LUDIOMIL 25MG TABLET 46132 MAPROTILINE HCL NOVARTIS 00083013530 LUDIOMIL 75MG TABLET 46134 MAPROTILINE HCL NOVARTIS 00085001204 TRILAFON 5MG/ML AMPUL 3828 PERPHENAZINE SCHERING CORPORATION 00085007705 TRILAFON 16MG TABLET 3830 PERPHENAZINE SCHERING CORPORATION 00085025104 PAXIPAM 20 MG TABLET 3776 HALAZEPAM SCHERING CORPORATION 00085028704 ETRAFON 2-10 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLSCHERING CORPORATION 00085028708 ETRAFON 2-10 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLSCHERING CORPORATION 00085029605 PERMITIL 5MG/ML ORAL CONC. 3822 FLUPHENAZINE HCL SCHERING CORPORATION 00085031305 TRILAFON 8MG TABLET 3833 PERPHENAZINE SCHERING CORPORATION 00085031605 PERMITIL 10MG TABLET 3824 FLUPHENAZINE HCL SCHERING CORPORATION 00085036302 TRILAFON 16MG/5ML ORAL CONC 3829 PERPHENAZINE SCHERING CORPORATION 00085044204 PERMITIL 2.5MG TABLET 3825 FLUPHENAZINE HCL SCHERING CORPORATION 00085053804 PAXIPAM 40 MG TABLET 3777 HALAZEPAM SCHERING CORPORATION 00085055004 PERMITIL 5MG TABLET 3826 FLUPHENAZINE HCL SCHERING CORPORATION 00085059804 ETRAFON 2-25 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLSCHERING CORPORATION 00085059808 ETRAFON 2-25 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLSCHERING CORPORATION 00085070504 TRILAFON 2MG TABLET 3831 PERPHENAZINE SCHERING CORPORATION 00085072004 ETRAFON FORTE 4-25 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLSCHERING CORPORATION 00085072008 ETRAFON FORTE 4-25 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLSCHERING CORPORATION 00085094005 TRILAFON 4MG TABLET 3832 PERPHENAZINE SCHERING CORPORATION 00087003147 SERZONE 50 MG TABLET 46253 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087003231 SERZONE 100 MG TABLET 46254 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087003244 SERZONE 100MG TABLET 46254 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087003331 SERZONE 200 MG TABLET 46256 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087003344 SERZONE 200MG TABLET 46256 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087003901 SERZONE 150MG TABLET 46255 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087003931 SERZONE 150 MG TABLET 46255 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087004131 SERZONE 250 MG TABLET 46257 NEFAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087077541 DESYREL 50 MG TABLET 46241 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087077542 DESYREL 50MG TABLET 46241 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 17 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00087077543 DESYREL 50 MG TABLET 46241 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087077641 DESYREL 100 MG TABLET 46242 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087077642 DESYREL 100MG TABLET 46242 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087077643 DESYREL 100 MG TABLET 46242 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087077843 DESYREL 150 MG TABLET 46243 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087077844 DESYREL 150 MG TABLET 46243 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087079641 DESYREL 300 MG TABLET 46244 TRAZODONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087081841 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087081843 BUSPAR 5MG TABLET 3782 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087081844 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087081941 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087081943 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087081944 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087082232 BUSPAR 15 MG TABLET 27378 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087082233 BUSPAR 15 MG TABLET 27378 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087082234 BUSPAR 15MG TABLET 27378 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00087082481 BUSPAR 30 MG TABLET 44210 BUSPIRONE HCL BRISTOL-MYERS SQUIBB COMPANY 00091332101 NIRAVAM 0.25 MG ODT 58847 ALPRAZOLAM SCHWARZ PHARMA, LLC 00091332201 NIRAVAM 0.5 MG ODT 58848 ALPRAZOLAM SCHWARZ PHARMA, LLC 00091332301 NIRAVAM 1 MG ODT 58849 ALPRAZOLAM SCHWARZ PHARMA, LLC 00091332401 NIRAVAM 2 MG ODT 58850 ALPRAZOLAM SCHWARZ PHARMA, LLC 00093003901 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093003905 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093003919 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093003993 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093005301 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC. 00093005305 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC. 00093005401 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC. 00093005405 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC. 00093005601 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE TEVA PHARMACEUTICALS USA, INC. 00093005701 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE TEVA PHARMACEUTICALS USA, INC. 00093007201 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE TEVA PHARMACEUTICALS USA, INC. 00093013201 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093019901 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093022105 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093022106 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093022505 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093022506 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093027501 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE TEVA PHARMACEUTICALS USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 18 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00093027601 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093027605 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093028001 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093028005 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093028019 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093028093 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093029001 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093029005 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093029019 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093029093 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093032501 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093032601 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093032701 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093046301 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093046305 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093046319 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093046393 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093055312 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE TEVA PHARMACEUTICALS USA, INC. 00093063701 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093063710 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093063801 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093063810 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093068801 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093078901 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE TEVA PHARMACEUTICALS USA, INC. 00093079001 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE TEVA PHARMACEUTICALS USA, INC. 00093079101 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE TEVA PHARMACEUTICALS USA, INC. 00093081001 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093081005 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093081101 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093081105 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093081201 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093081205 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093081301 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093081305 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL TEVA PHARMACEUTICALS USA, INC. 00093095601 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093095801 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093096001 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093100301 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC. 00093100305 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 19 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00093102406 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093102506 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093102606 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093104201 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093104210 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093104219 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093104293 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093104301 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093211101 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093211301 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093211701 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL TEVA PHARMACEUTICALS USA, INC. 00093435601 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093435605 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093435610 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093435619 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093435693 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093435901 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093435905 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093435919 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093435993 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093436001 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093436005 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093436019 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093436093 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440401 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440405 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440419 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440493 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440501 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440505 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440519 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093440593 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093474001 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474010 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474019 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474093 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474101 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474105 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474119 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 20 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00093474150 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474193 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474201 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474205 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474219 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474250 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093474293 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TEVA PHARMACEUTICALS USA, INC. 00093482001 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482005 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482010 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482101 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482105 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482110 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482201 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482205 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093482210 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM TEVA PHARMACEUTICALS USA, INC. 00093510501 OLANZAPINE 20 MG TABLET 41027 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093510505 OLANZAPINE 20 MG TABLET 41027 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093510556 OLANZAPINE 20 MG TABLET 41027 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093520005 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC. 00093520006 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL TEVA PHARMACEUTICALS USA, INC. 00093524519 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093524565 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093524619 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093524665 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093524719 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093524765 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093524819 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093524865 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093535005 BUDEPRION XL 150 MG TABLET 53006 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093535056 BUDEPRION XL 150 MG TABLET 53006 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093535105 BUDEPRION XL 300 MG TABLET 53007 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093535156 BUDEPRION XL 300 MG TABLET 53007 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093545006 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM TEVA PHARMACEUTICALS USA, INC. 00093545106 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM TEVA PHARMACEUTICALS USA, INC. 00093545206 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM TEVA PHARMACEUTICALS USA, INC. 00093545306 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM TEVA PHARMACEUTICALS USA, INC. 00093550101 BUDEPRION SR 100 MG TABLET 46239 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC. 00093550201 BUDEPRION SR 150 MG TABLET 46238 BUPROPION HCL TEVA PHARMACEUTICALS USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 21 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00093571501 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093571601 LAMOTRIGINE 25 MG DISPER TABS 21934 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093576701 OLANZAPINE 2.5 MG TABLET 29077 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576710 OLANZAPINE 2.5 MG TABLET 29077 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576756 OLANZAPINE 2.5 MG TABLET 29077 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576801 OLANZAPINE 5 MG TABLET 27961 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576810 OLANZAPINE 5 MG TABLET 27961 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576856 OLANZAPINE 5 MG TABLET 27961 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576901 OLANZAPINE 7.5 MG TABLET 27959 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576910 OLANZAPINE 7.5 MG TABLET 27959 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093576956 OLANZAPINE 7.5 MG TABLET 27959 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093577001 OLANZAPINE 10 MG TABLET 27960 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093577010 OLANZAPINE 10 MG TABLET 27960 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093577056 OLANZAPINE 10 MG TABLET 27960 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093577101 OLANZAPINE 15 MG TABLET 41026 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093577110 OLANZAPINE 15 MG TABLET 41026 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093577156 OLANZAPINE 15 MG TABLET 41026 OLANZAPINE TEVA PHARMACEUTICALS USA, INC. 00093585001 ESCITALOPRAM 5 MG TABLET 51642 ESCITALOPRAM OXALATE TEVA PHARMACEUTICALS USA, INC. 00093585005 ESCITALOPRAM 5 MG TABLET 51642 ESCITALOPRAM OXALATE TEVA PHARMACEUTICALS USA, INC. 00093585019 ESCITALOPRAM 5 MG TABLET 51642 ESCITALOPRAM OXALATE TEVA PHARMACEUTICALS USA, INC. 00093585093 ESCITALOPRAM 5 MG TABLET 51642 ESCITALOPRAM OXALATE TEVA PHARMACEUTICALS USA, INC. 00093585101 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE TEVA PHARMACEUTICALS USA, INC. 00093585201 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE TEVA PHARMACEUTICALS USA, INC. 00093610812 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093616931 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093711306 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093711456 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093711498 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093711556 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093711598 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093711656 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093711698 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093712156 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093712198 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093717510 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TEVA PHARMACEUTICALS USA, INC. 00093717556 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TEVA PHARMACEUTICALS USA, INC. 00093717610 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TEVA PHARMACEUTICALS USA, INC. 00093717656 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TEVA PHARMACEUTICALS USA, INC. 00093717710 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TEVA PHARMACEUTICALS USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 22 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00093717756 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TEVA PHARMACEUTICALS USA, INC. 00093717801 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL TEVA PHARMACEUTICALS USA, INC. 00093718810 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093718856 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093719801 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093719805 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093719819 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093719856 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093719893 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093720619 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720656 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720693 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720719 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720756 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720793 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720819 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720856 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093720893 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093722528 SELFEMRA 10 MG CAPSULE 46213 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093722628 SELFEMRA 20 MG CAPSULE 46214 FLUOXETINE HCL TEVA PHARMACEUTICALS USA, INC. 00093724005 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093724006 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093724105 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093724106 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093724205 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093724206 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093724306 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE TEVA PHARMACEUTICALS USA, INC. 00093724705 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093724706 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093724805 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093724806 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TEVA PHARMACEUTICALS USA, INC. 00093730365 MIRTAZAPINE 15 MG ODT 47453 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093730465 MIRTAZAPINE 30 MG ODT 47454 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093730565 MIRTAZAPINE 45 MG ODT 47636 MIRTAZAPINE TEVA PHARMACEUTICALS USA, INC. 00093734001 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM TEVA PHARMACEUTICALS USA, INC. 00093734005 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM TEVA PHARMACEUTICALS USA, INC. 00093738001 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738101 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738201 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 23 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00093738301 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738405 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738456 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738498 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738505 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738556 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738598 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738605 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738656 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093738698 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TEVA PHARMACEUTICALS USA, INC. 00093743901 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM TEVA PHARMACEUTICALS USA, INC. 00093744001 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM TEVA PHARMACEUTICALS USA, INC. 00093744005 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM TEVA PHARMACEUTICALS USA, INC. 00093744101 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM TEVA PHARMACEUTICALS USA, INC. 00093744105 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM TEVA PHARMACEUTICALS USA, INC. 00093777201 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093777205 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093777219 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093777293 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE TEVA PHARMACEUTICALS USA, INC. 00093816101 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816110 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816201 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816210 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816301 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816310 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816401 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816410 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816501 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816510 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816601 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093816610 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE TEVA PHARMACEUTICALS USA, INC. 00093960412 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE TEVA PHARMACEUTICALS USA, INC. 00093960423 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE TEVA PHARMACEUTICALS USA, INC. 00093961212 DOXEPIN 10 MG/ML ORAL CONC 46092 DOXEPIN HCL TEVA PHARMACEUTICALS USA, INC. 00093961312 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL TEVA PHARMACEUTICALS USA, INC. 00093963012 FLUPHENAZINE 5MG/ML CONC 3822 FLUPHENAZINE HCL TEVA PHARMACEUTICALS USA, INC. 00093963316 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM TEVA PHARMACEUTICALS USA, INC. 00093968616 FLUPHENAZINE 2.5MG/5ML ELIX 3821 FLUPHENAZINE HCL TEVA PHARMACEUTICALS USA, INC. 00108490142 STELAZINE 10MG/ML ORAL CONC 3850 TRIFLUOPERAZINE HCL GLAXOSMITHKLINE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 24 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00108490201 STELAZINE 2MG/ML VIAL 3849 TRIFLUOPERAZINE HCL GLAXOSMITHKLINE 00108490320 STELAZINE 1MG TABLET 3851 TRIFLUOPERAZINE HCL GLAXOSMITHKLINE 00108490420 STELAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL GLAXOSMITHKLINE 00108490620 STELAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL GLAXOSMITHKLINE 00108490720 STELAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL GLAXOSMITHKLINE 00115544513 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL GLOBAL PHARMACEUTICAL CORPORATION 00115681102 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL GLOBAL PHARMACEUTICAL CORPORATION 00115681108 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL GLOBAL PHARMACEUTICAL CORPORATION 00115681110 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL GLOBAL PHARMACEUTICAL CORPORATION 00115691101 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM GLOBAL PHARMACEUTICAL CORPORATION 00115691102 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM GLOBAL PHARMACEUTICAL CORPORATION 00115692201 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM GLOBAL PHARMACEUTICAL CORPORATION 00115692202 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM GLOBAL PHARMACEUTICAL CORPORATION 00121058104 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE PHARMACEUTICAL ASSOCIATES, INC. 00121058105 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE PHARMACEUTICAL ASSOCIATES, INC. 00121058110 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE PHARMACEUTICAL ASSOCIATES, INC. 00121065304 FLUPHENAZINE 5 MG/ML CONC 3822 FLUPHENAZINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121065402 FLUPHENAZINE 2.5 MG/5 ML ELIX 3821 FLUPHENAZINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121065416 FLUPHENAZINE 2.5 MG/5 ML ELIX 3821 FLUPHENAZINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121066104 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121066204 THIORIDAZINE 100MG/ML CONC 3857 THIORIDAZINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121067304 PERPHENAZINE ORAL SOLUTION 3829 PERPHENAZINE PHARMACEUTICAL ASSOCIATES, INC. 00121067505 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM PHARMACEUTICAL ASSOCIATES, INC. 00121067516 VALPROIC ACID 250 MG/5 ML SOLN 4535 VALPROATE SODIUM PHARMACEUTICAL ASSOCIATES, INC. 00121067812 NORTRIPTYLINE 25MG/12.5ML 46063 NORTRIPTYLINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121067816 NORTRIPTYLINE 10 MG/5 ML SOL 46063 NORTRIPTYLINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121072104 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121072105 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00121077001 LORAZEPAM 2 MG/ML ORAL CONCENT 16363 LORAZEPAM PHARMACEUTICAL ASSOCIATES, INC. 00121467505 VALPROIC ACID 250 MG/5 ML SOLN 68220 VALPROATE SODIUM PHARMACEUTICAL ASSOCIATES, INC. 00121467555 VALPROIC ACID 250 MG/5 ML SOLN 68220 VALPROATE SODIUM PHARMACEUTICAL ASSOCIATES, INC. 00121472105 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL PHARMACEUTICAL ASSOCIATES, INC. 00131326532 VENLAFAXINE HCL ER 37.5 MG TAB 64444 VENLAFAXINE HCL SCHWARZ PHARMA LLC 00131326546 VENLAFAXINE HCL ER 37.5 MG TAB 64444 VENLAFAXINE HCL SCHWARZ PHARMA LLC 00131326632 VENLAFAXINE HCL ER 75 MG TAB 64445 VENLAFAXINE HCL SCHWARZ PHARMA LLC 00131326646 VENLAFAXINE HCL ER 75 MG TAB 64445 VENLAFAXINE HCL SCHWARZ PHARMA LLC 00131326732 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL SCHWARZ PHARMA LLC 00131326746 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL SCHWARZ PHARMA LLC 00131326832 VENLAFAXINE HCL ER 225 MG TAB 64447 VENLAFAXINE HCL SCHWARZ PHARMA LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 25 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00131326846 VENLAFAXINE HCL ER 225 MG TAB 64447 VENLAFAXINE HCL SCHWARZ PHARMA LLC 00140000101 LIBRIUM 5MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000114 LIBRIUM 5MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000149 LIBRIUM 5MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000150 LIBRIUM 5MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000201 LIBRIUM 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000214 LIBRIUM 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000249 LIBRIUM 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000250 LIBRIUM 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000301 LIBRIUM 25MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000314 LIBRIUM 25MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140000401 VALIUM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00140000414 VALIUM 2MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00140000432 VALIUM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00140000501 VALIUM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00140000514 VALIUM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00140000535 VALIUM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00140000601 VALIUM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00140000614 VALIUM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00140000635 VALIUM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00140001301 LIBRITABS 5MG TABLET 3740 CHLORDIAZEPOXIDE LABELER NOT ON FILE 00140001401 LIBRITABS 10MG TABLET 3738 CHLORDIAZEPOXIDE LABELER NOT ON FILE 00140001501 LIBRITABS 25MG TABLET 3739 CHLORDIAZEPOXIDE LABELER NOT ON FILE 00140007001 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDELABELER NOT ON FILE 00140007014 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDELABELER NOT ON FILE 00140007049 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDELABELER NOT ON FILE 00140007101 LIMBITROL DS TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDELABELER NOT ON FILE 00140007114 LIMBITROL DS TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDELABELER NOT ON FILE 00140007149 LIMBITROL DS TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDELABELER NOT ON FILE 00140010601 ENDEP 10MG TABLET 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00140010701 ENDEP 25MG TABLET 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00140191206 LIBRIUM 100MG AMPUL 3737 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00140193106 VALIUM 5MG/ML AMPUL 3761 DIAZEPAM LABELER NOT ON FILE 00140193206 VALIUM 5MG/ML VIAL 3763 DIAZEPAM LABELER NOT ON FILE 00140193306 VALIUM 5MG/ML SYRINGE 3762 DIAZEPAM LABELER NOT ON FILE 00143127701 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143127709 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143127730 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143130001 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 26 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00143130010 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143318801 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143318901 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143318910 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143319001 LITHIUM CARBONATE 600 MG CAP 4002 LITHIUM CARBONATE WEST-WARD PHARMACEUTICAL CORP 00143958005 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143958009 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143958030 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143958105 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143958109 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143958130 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143958209 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143958230 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL WEST-WARD PHARMACEUTICAL CORP 00143978510 VALPROATE SOD 500 MG/5 ML VL 31533 VALPROATE SODIUM WEST-WARD PHARMACEUTICAL CORP 00144044451 HALOPERIDOL DEC 50 MG/ML VL 3967 HALOPERIDOL DECANOATE SUPERIOR PHARMACEUTICAL COMPANY 00144044456 HALOPERIDOL DEC 50 MG/ML VL 3967 HALOPERIDOL DECANOATE SUPERIOR PHARMACEUTICAL COMPANY 00144054451 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE SUPERIOR PHARMACEUTICAL COMPANY 00144054456 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE SUPERIOR PHARMACEUTICAL COMPANY 00144064456 FLUPHENAZINE DEC 25MG/ML VL 3818 FLUPHENAZINE DECANOATE SUPERIOR PHARMACEUTICAL COMPANY 00172366760 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172366770 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172366860 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172366870 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172366960 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172366970 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172367060 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172367070 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE IVAX PHARMACEUTICALS, INC. 00172392560 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392570 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392580 DIAZEPAM 2MG TABLET 3767 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392660 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392670 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392680 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392760 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392770 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172392780 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM IVAX PHARMACEUTICALS, INC. 00172430300 CLOZAPINE 12.5 MG TABLET 53016 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172430310 CLOZAPINE 12.5 MG TABLET 53016 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172430346 CLOZAPINE 12.5 MG TABLET 53016 CLOZAPINE IVAX PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 27 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00172430360 CLOZAPINE 12.5 MG TABLET 53016 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172433210 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433249 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433260 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433270 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433310 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433349 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433360 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433370 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433410 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433449 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433460 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433470 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433510 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433549 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172433560 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172434310 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172434349 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172434360 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL IVAX PHARMACEUTICALS, INC. 00172434610 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172434646 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172434660 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172434670 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172435600 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172435610 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172435660 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172435670 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172435680 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172435900 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172435910 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172435960 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172435970 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172436000 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172436010 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172436060 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172436070 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172436300 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172436310 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172436360 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 28 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00172436370 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172436380 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172438960 FLUVOXAMINE MALEATE 25 MG TB 46208 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172438970 FLUVOXAMINE MALEATE 25MG TB 46208 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172439160 FLUVOXAMINE MALEATE 50 MG TB 46209 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172439170 FLUVOXAMINE MALEATE 50MG TB 46209 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172439180 FLUVOXAMINE MALEATE 50MG TB 46209 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172439260 FLUVOXAMINE MAL 100 MG TAB 46210 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172439270 FLUVOXAMINE MAL 100MG TAB 46210 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172439280 FLUVOXAMINE MAL 100MG TAB 46210 FLUVOXAMINE MALEATE IVAX PHARMACEUTICALS, INC. 00172440410 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172440460 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172440470 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172440510 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172440560 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172440570 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE IVAX PHARMACEUTICALS, INC. 00172451060 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172451070 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172451080 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL IVAX PHARMACEUTICALS, INC. 00172474000 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474010 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474060 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474080 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474100 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474110 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474160 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474170 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474185 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474200 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474210 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474260 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474270 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172474285 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE IVAX PHARMACEUTICALS, INC. 00172480460 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM IVAX PHARMACEUTICALS, INC. 00172480470 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM IVAX PHARMACEUTICALS, INC. 00172480560 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM IVAX PHARMACEUTICALS, INC. 00172480570 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM IVAX PHARMACEUTICALS, INC. 00172480660 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM IVAX PHARMACEUTICALS, INC. 00172480670 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM IVAX PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 29 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00172483560 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172483570 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172483580 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172483760 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172483770 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172483780 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172484560 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172484570 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM IVAX PHARMACEUTICALS, INC. 00172566300 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566310 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566360 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566370 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566400 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566410 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566460 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566470 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566560 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566565 BUSPIRONE HCL 15MG TABLET 27378 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172566570 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL IVAX PHARMACEUTICALS, INC. 00172567210 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL IVAX PHARMACEUTICALS, INC. 00172567280 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL IVAX PHARMACEUTICALS, INC. 00172567300 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL IVAX PHARMACEUTICALS, INC. 00172567310 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL IVAX PHARMACEUTICALS, INC. 00172567410 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL IVAX PHARMACEUTICALS, INC. 00172567500 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172567510 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172567546 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172567570 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172567600 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172567610 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172567646 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172567670 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172569500 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172569510 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172569546 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00172569570 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE IVAX PHARMACEUTICALS, INC. 00173013555 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL GLAXOSMITHKLINE 00173017755 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL GLAXOSMITHKLINE 00173017855 WELLBUTRIN 100 MG TABLET 46237 BUPROPION HCL GLAXOSMITHKLINE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 30 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00173052600 LAMICTAL 5 MG DISPER TABLET 21935 LAMOTRIGINE GLAXOSMITHKLINE 00173052700 LAMICTAL 25 MG DISPER TABLET 21934 LAMOTRIGINE GLAXOSMITHKLINE 00173059401 LAMICTAL TAB START KIT (GREEN) 58517 LAMOTRIGINE GLAXOSMITHKLINE 00173059402 LAMICTAL TB START KIT (ORANGE) 58518 LAMOTRIGINE GLAXOSMITHKLINE 00173063302 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE GLAXOSMITHKLINE 00173063310 LAMICTAL TAB START KIT (BLUE) 58516 LAMOTRIGINE GLAXOSMITHKLINE 00173064255 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE GLAXOSMITHKLINE 00173064360 LAMICTAL 150 MG TABLET 22550 LAMOTRIGINE GLAXOSMITHKLINE 00173064460 LAMICTAL 200 MG TABLET 22551 LAMOTRIGINE GLAXOSMITHKLINE 00173072200 WELLBUTRIN SR 200 MG TABLET 50496 BUPROPION HCL GLAXOSMITHKLINE 00173073001 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL GLAXOSMITHKLINE 00173073002 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL GLAXOSMITHKLINE 00173073101 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL GLAXOSMITHKLINE 00173075400 LAMICTAL XR 25 MG TABLET 65250 LAMOTRIGINE GLAXOSMITHKLINE 00173075500 LAMICTAL XR 50 MG TABLET 65251 LAMOTRIGINE GLAXOSMITHKLINE 00173075600 LAMICTAL XR 100 MG TABLET 65252 LAMOTRIGINE GLAXOSMITHKLINE 00173075700 LAMICTAL XR 200 MG TABLET 65253 LAMOTRIGINE GLAXOSMITHKLINE 00173075800 LAMICTAL XR START KIT (BLUE) 65254 LAMOTRIGINE GLAXOSMITHKLINE 00173075900 LAMICTAL XR START KIT (GREEN) 65255 LAMOTRIGINE GLAXOSMITHKLINE 00173076000 LAMICTAL XR START KIT (ORANGE) 65256 LAMOTRIGINE GLAXOSMITHKLINE 00173076100 LAMICTAL XR 300 MG TABLET 67221 LAMOTRIGINE GLAXOSMITHKLINE 00173077202 LAMICTAL ODT 25 MG TABLET 65167 LAMOTRIGINE GLAXOSMITHKLINE 00173077402 LAMICTAL ODT 50 MG TABLET 65166 LAMOTRIGINE GLAXOSMITHKLINE 00173077602 LAMICTAL ODT 100 MG TABLET 65168 LAMOTRIGINE GLAXOSMITHKLINE 00173077702 LAMICTAL ODT 200 MG TABLET 65169 LAMOTRIGINE GLAXOSMITHKLINE 00173077800 LAMICTAL ODT START KT (ORANGE) 65170 LAMOTRIGINE GLAXOSMITHKLINE 00173077900 LAMICTAL ODT START KIT (BLUE) 65171 LAMOTRIGINE GLAXOSMITHKLINE 00173078000 LAMICTAL ODT START KIT (GREEN) 65172 LAMOTRIGINE GLAXOSMITHKLINE 00173078100 LAMICTAL XR 250 MG TABLET 68093 LAMOTRIGINE GLAXOSMITHKLINE 00173081728 LAMICTAL TAB START KIT (GREEN) 58517 LAMOTRIGINE GLAXOSMITHKLINE 00173094755 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL GLAXOSMITHKLINE 00182000901 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM GOLDLINE LABORATORIES, INC. 00182000905 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM GOLDLINE LABORATORIES, INC. 00182001001 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM GOLDLINE LABORATORIES, INC. 00182001005 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM GOLDLINE LABORATORIES, INC. 00182001401 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM GOLDLINE LABORATORIES, INC. 00182002701 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM GOLDLINE LABORATORIES, INC. 00182002705 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM GOLDLINE LABORATORIES, INC. 00182002801 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM GOLDLINE LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 31 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00182002901 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM GOLDLINE LABORATORIES, INC. 00182002905 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM GOLDLINE LABORATORIES, INC. 00182003001 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM GOLDLINE LABORATORIES, INC. 00182009463 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182029401 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE GOLDLINE LABORATORIES, INC. 00182029410 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE GOLDLINE LABORATORIES, INC. 00182047401 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182047410 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182047501 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182047510 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182047601 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182047610 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182047701 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182047710 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182082601 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182082701 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182082710 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182082789 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182082801 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182082810 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182082889 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182085963 CHLORPROMAZINE 25MG/ML VIAL 3790 CHLORPROMAZINE HCL GOLDLINE LABORATORIES, INC. 00182097701 CDP 5MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL GOLDLINE LABORATORIES, INC. 00182097801 CDP 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL GOLDLINE LABORATORIES, INC. 00182097805 CDP 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL GOLDLINE LABORATORIES, INC. 00182097810 CDP 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL GOLDLINE LABORATORIES, INC. 00182097889 CDP 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL GOLDLINE LABORATORIES, INC. 00182097901 CDP 25MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL GOLDLINE LABORATORIES, INC. 00182101889 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182101910 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182101989 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182102010 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182102089 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182102189 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182104301 AMOXAPINE 25MG TABLET 46083 AMOXAPINE GOLDLINE LABORATORIES, INC. 00182104401 AMOXAPINE 50MG TABLET 46084 AMOXAPINE GOLDLINE LABORATORIES, INC. 00182104501 AMOXAPINE 100MG TABLET 46081 AMOXAPINE GOLDLINE LABORATORIES, INC. 00182104617 AMOXAPINE 150MG TABLET 46082 AMOXAPINE GOLDLINE LABORATORIES, INC. 00182106389 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL GOLDLINE LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 32 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00182119001 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182119101 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182119201 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182119301 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182123001 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM GOLDLINE LABORATORIES, INC. 00182123101 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM GOLDLINE LABORATORIES, INC. 00182123201 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM GOLDLINE LABORATORIES, INC. 00182123501 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLGOLDLINE LABORATORIES, INC. 00182123505 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLGOLDLINE LABORATORIES, INC. 00182123601 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLGOLDLINE LABORATORIES, INC. 00182123605 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLGOLDLINE LABORATORIES, INC. 00182123701 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLGOLDLINE LABORATORIES, INC. 00182123801 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLGOLDLINE LABORATORIES, INC. 00182123805 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLGOLDLINE LABORATORIES, INC. 00182125900 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182125901 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182125910 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182125989 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182126000 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182126001 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182126005 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182126010 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182126089 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182126201 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182126205 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182126301 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182126305 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182126401 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182126501 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182126505 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182129801 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL GOLDLINE LABORATORIES, INC. 00182130601 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE GOLDLINE LABORATORIES, INC. 00182130801 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE GOLDLINE LABORATORIES, INC. 00182131601 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182132501 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182132601 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182132701 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182132789 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182132801 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL GOLDLINE LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 33 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00182132889 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182132901 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182132989 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182133201 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182133210 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182133289 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182133301 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182133310 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182133389 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182133501 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182136501 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL GOLDLINE LABORATORIES, INC. 00182136601 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL GOLDLINE LABORATORIES, INC. 00182136701 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL GOLDLINE LABORATORIES, INC. 00182136789 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL GOLDLINE LABORATORIES, INC. 00182136801 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL GOLDLINE LABORATORIES, INC. 00182136889 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL GOLDLINE LABORATORIES, INC. 00182175401 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID GOLDLINE LABORATORIES, INC. 00182175501 DIAZEPAM 2MG TABLET 3767 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175505 DIAZEPAM 2MG TABLET 3767 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175589 DIAZEPAM 2MG TABLET 3767 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175601 DIAZEPAM 5MG TABLET 3768 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175605 DIAZEPAM 5MG TABLET 3768 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175610 DIAZEPAM 5MG TABLET 3768 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175701 DIAZEPAM 10MG TABLET 3766 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175705 DIAZEPAM 10MG TABLET 3766 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175710 DIAZEPAM 10MG TABLET 3766 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182175789 DIAZEPAM 10MG TABLET 3766 DIAZEPAM GOLDLINE LABORATORIES, INC. 00182178101 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE GOLDLINE LABORATORIES, INC. 00182178110 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE GOLDLINE LABORATORIES, INC. 00182180601 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180605 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180689 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180701 LORAZEPAM 1MG TABLET 3758 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180705 LORAZEPAM 1MG TABLET 3758 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180710 LORAZEPAM 1MG TABLET 3758 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180789 LORAZEPAM 1MG TABLET 3758 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180801 LORAZEPAM 2MG TABLET 3759 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180805 LORAZEPAM 2MG TABLET 3759 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182180889 LORAZEPAM 2MG TABLET 3759 LORAZEPAM GOLDLINE LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 34 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00182185401 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182185405 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL GOLDLINE LABORATORIES, INC. 00182186501 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186589 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186601 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186605 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186689 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186701 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186705 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186789 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182186801 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE GOLDLINE LABORATORIES, INC. 00182187801 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182188201 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL GOLDLINE LABORATORIES, INC. 00182188301 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL GOLDLINE LABORATORIES, INC. 00182188401 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL GOLDLINE LABORATORIES, INC. 00182264301 PROTRIPTYLINE 5MG TABLET 46080 PROTRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182264401 PROTRIPTYLINE 10MG TABLET 46079 PROTRIPTYLINE HCL GOLDLINE LABORATORIES, INC. 00182265201 DESIPRAMINE 10MG TABLET 46103 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182265319 DESIPRAMINE 150MG TABLET 46105 DESIPRAMINE HCL GOLDLINE LABORATORIES, INC. 00182404119 ST. JOHN'S WORT 300MG CAP 46333 ST. JOHN'S WORT GOLDLINE LABORATORIES, INC. 00182407926 ST. JOHN'S WORT 300 MG SFTGL 46333 ST. JOHN'S WORT GOLDLINE LABORATORIES, INC. 00182604371 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL GOLDLINE LABORATORIES, INC. 00182605964 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE GOLDLINE LABORATORIES, INC. 00182605971 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE GOLDLINE LABORATORIES, INC. 00182611271 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL GOLDLINE LABORATORIES, INC. 00182611540 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM GOLDLINE LABORATORIES, INC. 00182614840 LITHIUM CIT 8MEQ/5ML SYRUP 4006 LITHIUM CITRATE GOLDLINE LABORATORIES, INC. 00182823700 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182823789 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182823800 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182823889 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182823900 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM GOLDLINE LABORATORIES, INC. 00182823989 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM GOLDLINE LABORATORIES, INC. 00185001660 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL EON LABS, INC. 00185001701 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE EON LABS, INC. 00185001901 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL EON LABS, INC. 00185001905 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL EON LABS, INC. 00185001910 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL EON LABS, INC. 00185002010 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE EON LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 35 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00185002030 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE EON LABS, INC. 00185002701 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE EON LABS, INC. 00185002705 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE EON LABS, INC. 00185002788 FLUVOXAMINE MALEATE 50MG TB 46209 FLUVOXAMINE MALEATE EON LABS, INC. 00185002901 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL EON LABS, INC. 00185003860 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL EON LABS, INC. 00185005730 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL EON LABS, INC. 00185008001 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL EON LABS, INC. 00185008010 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL EON LABS, INC. 00185008160 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL EON LABS, INC. 00185008501 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL EON LABS, INC. 00185008510 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL EON LABS, INC. 00185012660 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL EON LABS, INC. 00185014860 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL EON LABS, INC. 00185015330 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL EON LABS, INC. 00185015701 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE EON LABS, INC. 00185015705 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE EON LABS, INC. 00185019560 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM EON LABS, INC. 00185019660 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM EON LABS, INC. 00185019760 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM EON LABS, INC. 00185019860 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM EON LABS, INC. 00185021210 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE EON LABS, INC. 00185021230 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE EON LABS, INC. 00185022210 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE EON LABS, INC. 00185022230 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE EON LABS, INC. 00185026530 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL EON LABS, INC. 00185037101 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE EON LABS, INC. 00185037110 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE EON LABS, INC. 00185037201 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE EON LABS, INC. 00185037210 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE EON LABS, INC. 00185037301 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE EON LABS, INC. 00185037310 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE EON LABS, INC. 00185041001 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL EON LABS, INC. 00185041005 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL EON LABS, INC. 00185041060 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL EON LABS, INC. 00185041501 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL EON LABS, INC. 00185041505 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL EON LABS, INC. 00185041552 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL EON LABS, INC. 00185041560 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL EON LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 36 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00185071601 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE EON LABS, INC. 00185071610 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE EON LABS, INC. 00185071701 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE EON LABS, INC. 00185071710 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE EON LABS, INC. 00185072101 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL EON LABS, INC. 00185072105 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL EON LABS, INC. 00185072110 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL EON LABS, INC. 00185072201 DESIPRAMINE 75 MG TABLET 46108 DESIPRAMINE HCL EON LABS, INC. 00185072205 DESIPRAMINE 75 MG TABLET 46108 DESIPRAMINE HCL EON LABS, INC. 00185073601 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL EON LABS, INC. 00185073605 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL EON LABS, INC. 00185076053 DESIPRAMINE 150 MG TABLET 46105 DESIPRAMINE HCL EON LABS, INC. 00185111160 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL EON LABS, INC. 00186122103 DROPERIDOL 2.5MG/ML AMPUL 3964 DROPERIDOL ASTRAZENECA LP 00186122713 DROPERIDOL 2.5MG/ML VIAL 3965 DROPERIDOL ASTRAZENECA LP 00187320110 LIBRIUM 100MG AMPUL 3737 CHLORDIAZEPOXIDE HCL VALEANT PHARMACEUTICALS NORTH AMERICA 00187375010 LIBRIUM 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL VALEANT PHARMACEUTICALS NORTH AMERICA 00187375110 LIBRIUM 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL VALEANT PHARMACEUTICALS NORTH AMERICA 00187375574 LIBRIUM 100 MG AMPUL 3737 CHLORDIAZEPOXIDE HCL VALEANT PHARMACEUTICALS NORTH AMERICA 00187375810 LIBRIUM 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL VALEANT PHARMACEUTICALS NORTH AMERICA 00187380510 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEVALEANT PHARMACEUTICALS NORTH AMERICA 00187380610 LIMBITROL DS TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEVALEANT PHARMACEUTICALS NORTH AMERICA 00205281046 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM LEDERLE PARENTERALS 00205538534 LOXITANE IM 50MG/ML VIAL 3979 LOXAPINE HCL LEDERLE PARENTERALS 00223102101 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL LABELER NOT ON FILE 00223212801 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL LABELER NOT ON FILE 00223212802 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL LABELER NOT ON FILE 00223212901 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL LABELER NOT ON FILE 00223212902 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL LABELER NOT ON FILE 00223213001 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL LABELER NOT ON FILE 00223213002 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL LABELER NOT ON FILE 00223213101 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL LABELER NOT ON FILE 00223213102 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL LABELER NOT ON FILE 00223213202 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL LABELER NOT ON FILE 00223213301 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL LABELER NOT ON FILE 00223213302 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL LABELER NOT ON FILE 00223213401 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL LABELER NOT ON FILE 00223213402 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL LABELER NOT ON FILE 00228202710 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ACTAVIS ELIZABETH LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 37 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00228202750 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228202796 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228202910 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228202950 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228202996 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228203110 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228203150 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228203196 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228203910 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228203950 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228205110 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM ACTAVIS ELIZABETH LLC 00228205150 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM ACTAVIS ELIZABETH LLC 00228205210 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ACTAVIS ELIZABETH LLC 00228205250 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ACTAVIS ELIZABETH LLC 00228205296 DIAZEPAM 5MG TABLET 3768 DIAZEPAM ACTAVIS ELIZABETH LLC 00228205310 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ACTAVIS ELIZABETH LLC 00228205350 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ACTAVIS ELIZABETH LLC 00228205710 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM ACTAVIS ELIZABETH LLC 00228205750 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM ACTAVIS ELIZABETH LLC 00228205910 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ACTAVIS ELIZABETH LLC 00228205950 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ACTAVIS ELIZABETH LLC 00228206310 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM ACTAVIS ELIZABETH LLC 00228206350 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM ACTAVIS ELIZABETH LLC 00228206710 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM ACTAVIS ELIZABETH LLC 00228206750 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM ACTAVIS ELIZABETH LLC 00228206910 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM ACTAVIS ELIZABETH LLC 00228206950 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM ACTAVIS ELIZABETH LLC 00228207310 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM ACTAVIS ELIZABETH LLC 00228207350 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM ACTAVIS ELIZABETH LLC 00228213110 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228213196 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228213210 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228213296 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228213310 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228213396 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228213410 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228213510 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL ACTAVIS ELIZABETH LLC 00228223296 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ACTAVIS ELIZABETH LLC 00228223310 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ACTAVIS ELIZABETH LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 38 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00228228010 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228050 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228110 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228150 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228210 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228250 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228610 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228650 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228710 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228750 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228910 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228228950 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL ACTAVIS ELIZABETH LLC 00228243910 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ACTAVIS ELIZABETH LLC 00228243950 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ACTAVIS ELIZABETH LLC 00228244110 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL ACTAVIS ELIZABETH LLC 00228245510 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID ACTAVIS ELIZABETH LLC 00228265511 FLUVOXAMINE MALEATE 50MG TB 46209 FLUVOXAMINE MALEATE ACTAVIS ELIZABETH LLC 00228265550 FLUVOXAMINE MALEATE 50MG TB 46209 FLUVOXAMINE MALEATE ACTAVIS ELIZABETH LLC 00228265611 FLUVOXAMINE MAL 100MG TAB 46210 FLUVOXAMINE MALEATE ACTAVIS ELIZABETH LLC 00228265650 FLUVOXAMINE MAL 100MG TAB 46210 FLUVOXAMINE MALEATE ACTAVIS ELIZABETH LLC 00228270211 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL ACTAVIS ELIZABETH LLC 00228270311 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL ACTAVIS ELIZABETH LLC 00228270411 FLUVOXAMINE MALEATE 25MG TB 46208 FLUVOXAMINE MALEATE ACTAVIS ELIZABETH LLC 00228270450 FLUVOXAMINE MALEATE 25MG TB 46208 FLUVOXAMINE MALEATE ACTAVIS ELIZABETH LLC 00228272103 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272109 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272150 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272203 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272209 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272290 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272303 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272309 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228272396 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ACTAVIS ELIZABETH LLC 00228275511 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE ACTAVIS ELIZABETH LLC 00228275611 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE ACTAVIS ELIZABETH LLC 00228275650 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE ACTAVIS ELIZABETH LLC 00228275711 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE ACTAVIS ELIZABETH LLC 00228275750 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE ACTAVIS ELIZABETH LLC 00228306711 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ACTAVIS ELIZABETH LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 39 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00228306750 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ACTAVIS ELIZABETH LLC 00228306811 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ACTAVIS ELIZABETH LLC 00228306850 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ACTAVIS ELIZABETH LLC 00228306911 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ACTAVIS ELIZABETH LLC 00228308306 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228308406 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228308606 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228308706 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228401911 ALPRAZOLAM 0.25 MG ODT 58847 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228402211 ALPRAZOLAM 0.5 MG ODT 58848 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228402411 ALPRAZOLAM 1 MG ODT 58849 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00228402511 ALPRAZOLAM 2 MG ODT 58850 ALPRAZOLAM ACTAVIS ELIZABETH LLC 00245018001 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018011 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018015 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018089 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018101 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018111 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018115 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018189 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018201 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018211 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018215 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245018289 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UPSHER-SMITH LABORATORIES, INC. 00245045060 ALTERRA 450MG TABLET SA 46338 ST. JOHN'S WORT UPSHER-SMITH LABORATORIES, INC. 00247003807 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003814 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003815 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003820 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003825 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003830 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003840 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003860 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247003890 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00247017900 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 00247017907 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 00247017914 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 00247017930 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 00247018700 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 40 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00247018702 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018703 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018704 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018706 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018707 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018710 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018712 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018714 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018715 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018720 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018721 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018728 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018730 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018750 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247018798 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00247020801 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00247020807 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00247020810 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00247020814 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00247020830 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00247020907 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00247020908 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00247020912 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00247020914 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00247020916 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00247020920 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00247020930 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00247021002 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00247021004 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00247021007 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00247021008 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00247021014 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00247021030 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00247037106 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 00247037107 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 00247037110 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 00247037114 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 00247037128 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 00247037130 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 41 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00247037150 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 00247037160 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 00247037200 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037203 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037207 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037214 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037215 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037228 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037230 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037252 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247037260 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00247049300 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247049302 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247049306 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247049307 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247049310 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247049312 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247049314 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247049330 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00247061420 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061430 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061450 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061460 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061490 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061500 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061504 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061507 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061512 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061515 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061530 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061560 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247061590 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247064407 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00247064410 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00247064414 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00247064428 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00247064430 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00247064460 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00247065201 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 42 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00247065203 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00247065206 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00247065210 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00247065230 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00247065260 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00247067507 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 00247067514 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 00247067530 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 00247067590 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 00247067607 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 00247067614 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 00247067630 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 00247067660 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 00247067707 WELLBUTRIN 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 00247067714 WELLBUTRIN 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 00247067730 WELLBUTRIN 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 00247067760 WELLBUTRIN 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 00247069730 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 00247077300 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 00247077330 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 00247077390 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 00247078000 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 00247078001 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 00247079007 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00247079014 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00247079030 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00247079050 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00247079107 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00247079114 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00247079607 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE LABELER NOT ON FILE 00247079614 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE LABELER NOT ON FILE 00247079630 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE LABELER NOT ON FILE 00247079707 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 00247079714 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 00247079730 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 00247079750 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 00247079807 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE LABELER NOT ON FILE 00247079814 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE LABELER NOT ON FILE 00247079830 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 43 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00247079907 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE LABELER NOT ON FILE 00247079914 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE LABELER NOT ON FILE 00247079930 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE LABELER NOT ON FILE 00247080807 MAPROTILINE 25 MG TABLET 46132 MAPROTILINE HCL LABELER NOT ON FILE 00247080814 MAPROTILINE 25 MG TABLET 46132 MAPROTILINE HCL LABELER NOT ON FILE 00247080830 MAPROTILINE 25 MG TABLET 46132 MAPROTILINE HCL LABELER NOT ON FILE 00247080907 MAPROTILINE 50 MG TABLET 46133 MAPROTILINE HCL LABELER NOT ON FILE 00247080914 MAPROTILINE 50 MG TABLET 46133 MAPROTILINE HCL LABELER NOT ON FILE 00247080930 MAPROTILINE 50 MG TABLET 46133 MAPROTILINE HCL LABELER NOT ON FILE 00247081007 MAPROTILINE 75 MG TABLET 46134 MAPROTILINE HCL LABELER NOT ON FILE 00247081014 MAPROTILINE 75 MG TABLET 46134 MAPROTILINE HCL LABELER NOT ON FILE 00247081030 MAPROTILINE 75 MG TABLET 46134 MAPROTILINE HCL LABELER NOT ON FILE 00247081500 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL LABELER NOT ON FILE 00247081530 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL LABELER NOT ON FILE 00247081630 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL LABELER NOT ON FILE 00247082300 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00247082301 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00247082320 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00247082330 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00247085306 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 00247085330 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 00247085360 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 00247085390 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 00247093903 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00247093906 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00247093930 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00247095920 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 00247103128 MEPROBAMATE 400 MG TABLET 3714 MEPROBAMATE LABELER NOT ON FILE 00247103560 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 00247103590 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 00247105950 ELAVIL 10 MG TABLET 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247105960 ELAVIL 10 MG TABLET 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247106050 ELAVIL 25 MG TABLET 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247106060 ELAVIL 25 MG TABLET 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247117707 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 00247117730 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 00247120100 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247120130 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247123230 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 44 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00247123330 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL LABELER NOT ON FILE 00247124230 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 00247124330 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 00254494028 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VINTAGE PHARMACEUTICALS, INC. 00254494035 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VINTAGE PHARMACEUTICALS, INC. 00254494128 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VINTAGE PHARMACEUTICALS, INC. 00254494135 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VINTAGE PHARMACEUTICALS, INC. 00254494228 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VINTAGE PHARMACEUTICALS, INC. 00254494235 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VINTAGE PHARMACEUTICALS, INC. 00254494328 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE VINTAGE PHARMACEUTICALS, INC. 00258369501 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE INWOOD LABORATORIES INC 00258369505 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE INWOOD LABORATORIES INC 00258369601 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE INWOOD LABORATORIES INC 00258369610 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE INWOOD LABORATORIES INC 00258369701 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE INWOOD LABORATORIES INC 00258369710 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE INWOOD LABORATORIES INC 00310004010 ELAVIL 10 MG TABLET 46043 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004034 ELAVIL 10MG TABLET 46043 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004110 ELAVIL 50 MG TABLET 46047 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004134 ELAVIL 50MG TABLET 46047 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004139 ELAVIL 50MG TABLET 46047 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004210 ELAVIL 75 MG TABLET 46048 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004310 ELAVIL 100MG TABLET 46044 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004510 ELAVIL 25MG TABLET 46046 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004534 ELAVIL 25MG TABLET 46046 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004539 ELAVIL 25MG TABLET 46046 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004550 ELAVIL 25 MG TABLET 46046 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004710 ELAVIL 150MG TABLET 46045 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004730 ELAVIL 150MG TABLET 46045 AMITRIPTYLINE HCL ASTRAZENECA LP 00310004910 ELAVIL 10MG/ML VIAL 46042 AMITRIPTYLINE HCL ASTRAZENECA LP 00310027110 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027139 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027210 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027239 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027439 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027460 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027510 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027534 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027539 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE ASTRAZENECA LP

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 45 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00310027810 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027834 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027839 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027910 SEROQUEL 400 MG TABLET 60293 QUETIAPINE FUMARATE ASTRAZENECA LP 00310027939 SEROQUEL 400 MG TABLET 60293 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028039 SEROQUEL XR 50 MG TABLET 63240 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028060 SEROQUEL XR 50 MG TABLET 63240 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028139 SEROQUEL XR 150 MG TABLET 64725 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028160 SEROQUEL XR 150 MG TABLET 64725 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028239 SEROQUEL XR 200 MG TABLET 62748 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028255 SEROQUEL XR 200 MG TABLET 62748 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028260 SEROQUEL XR 200 MG TABLET 62748 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028339 SEROQUEL XR 300 MG TABLET 62749 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028355 SEROQUEL XR 300 MG TABLET 62749 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028360 SEROQUEL XR 300 MG TABLET 62749 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028439 SEROQUEL XR 400 MG TABLET 62750 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028455 SEROQUEL XR 400 MG TABLET 62750 QUETIAPINE FUMARATE ASTRAZENECA LP 00310028460 SEROQUEL XR 400 MG TABLET 62750 QUETIAPINE FUMARATE ASTRAZENECA LP 00332211109 46068 IMIPRAMINE HCL BIOCRAFT LABORATORIES, INC. 00332211115 46068 IMIPRAMINE HCL BIOCRAFT LABORATORIES, INC. 00332211309 46069 IMIPRAMINE HCL BIOCRAFT LABORATORIES, INC. 00332211715 46070 IMIPRAMINE HCL BIOCRAFT LABORATORIES, INC. 00339577112 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 00339577312 LITHIUM CARBONATE 300MG TAB 4003 LITHIUM CARBONATE LABELER NOT ON FILE 00349104010 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL PARMED PHARMACEUTICALS INC. 00349104101 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL PARMED PHARMACEUTICALS INC. 00349104110 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL PARMED PHARMACEUTICALS INC. 00349104201 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL PARMED PHARMACEUTICALS INC. 00349104210 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL PARMED PHARMACEUTICALS INC. 00349104301 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL PARMED PHARMACEUTICALS INC. 00349204001 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL PARMED PHARMACEUTICALS INC. 00349204101 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL PARMED PHARMACEUTICALS INC. 00349204301 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL PARMED PHARMACEUTICALS INC. 00349207901 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349207910 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349208001 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349208010 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349208101 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349236601 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL PARMED PHARMACEUTICALS INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 46 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00349236701 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL PARMED PHARMACEUTICALS INC. 00349846101 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM PARMED PHARMACEUTICALS INC. 00349846301 LORAZEPAM 2MG TABLET 3759 LORAZEPAM PARMED PHARMACEUTICALS INC. 00349870301 AMOXAPINE 50MG TABLET 46084 AMOXAPINE PARMED PHARMACEUTICALS INC. 00349870901 AMOXAPINE 100MG TABLET 46081 AMOXAPINE PARMED PHARMACEUTICALS INC. 00349872801 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349872901 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349872910 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349876401 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL PARMED PHARMACEUTICALS INC. 00349882401 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL PARMED PHARMACEUTICALS INC. 00349882425 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL PARMED PHARMACEUTICALS INC. 00349883901 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE PARMED PHARMACEUTICALS INC. 00349886601 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM PARMED PHARMACEUTICALS INC. 00349888201 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLPARMED PHARMACEUTICALS INC. 00349888205 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLPARMED PHARMACEUTICALS INC. 00349890601 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL PARMED PHARMACEUTICALS INC. 00349890605 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL PARMED PHARMACEUTICALS INC. 00349890701 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL PARMED PHARMACEUTICALS INC. 00349894501 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL PARMED PHARMACEUTICALS INC. 00349894601 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL PARMED PHARMACEUTICALS INC. 00349894701 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL PARMED PHARMACEUTICALS INC. 00349894801 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL PARMED PHARMACEUTICALS INC. 00349897901 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL PARMED PHARMACEUTICALS INC. 00349898101 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL PARMED PHARMACEUTICALS INC. 00349898201 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL PARMED PHARMACEUTICALS INC. 00349898301 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL PARMED PHARMACEUTICALS INC. 00364016001 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE WATSON PHARMA, INC. 00364016002 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE WATSON PHARMA, INC. 00364016101 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 00364016102 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 00364038001 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00364043501 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL WATSON PHARMA, INC. 00364043502 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL WATSON PHARMA, INC. 00364057301 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364057302 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364057401 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364057402 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364057501 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364057502 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 47 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00364057601 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364057701 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364057801 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00364066201 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL WATSON PHARMA, INC. 00364066901 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL WATSON PHARMA, INC. 00364067001 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL WATSON PHARMA, INC. 00364072301 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL WATSON PHARMA, INC. 00364072401 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL WATSON PHARMA, INC. 00364077401 DIAZEPAM 2MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00364077402 DIAZEPAM 2MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00364077405 DIAZEPAM 2MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00364077501 DIAZEPAM 5MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00364077502 DIAZEPAM 5MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00364077505 DIAZEPAM 5MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00364077601 DIAZEPAM 10MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00364077602 DIAZEPAM 10MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00364077605 DIAZEPAM 10MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00364079301 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 00364079305 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 00364079401 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 00364079405 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 00364079501 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 00364079505 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 00364082201 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID WATSON PHARMA, INC. 00364082554 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM WATSON PHARMA, INC. 00364085472 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE WATSON PHARMA, INC. 00364085477 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE WATSON PHARMA, INC. 00364085501 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE WATSON PHARMA, INC. 00364210901 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL WATSON PHARMA, INC. 00364210902 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL WATSON PHARMA, INC. 00364211001 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL WATSON PHARMA, INC. 00364211002 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL WATSON PHARMA, INC. 00364211301 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL WATSON PHARMA, INC. 00364211390 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL WATSON PHARMA, INC. 00364211401 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 00364211402 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 00364211490 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 00364211501 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC. 00364211502 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 48 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00364211590 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC. 00364211601 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL WATSON PHARMA, INC. 00364211701 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL WATSON PHARMA, INC. 00364211790 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL WATSON PHARMA, INC. 00364213916 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM WATSON PHARMA, INC. 00364214016 LITHIUM CIT 8MEQ/5ML SYRUP 4006 LITHIUM CITRATE WATSON PHARMA, INC. 00364215201 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM WATSON PHARMA, INC. 00364215401 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM WATSON PHARMA, INC. 00364216601 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE WATSON PHARMA, INC. 00364216701 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE WATSON PHARMA, INC. 00364216702 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE WATSON PHARMA, INC. 00364216801 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE WATSON PHARMA, INC. 00364216802 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE WATSON PHARMA, INC. 00364216901 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE WATSON PHARMA, INC. 00364216902 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE WATSON PHARMA, INC. 00364220101 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00364220105 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00364220201 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00364220205 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00364220301 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00364220401 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL WATSON PHARMA, INC. 00364220501 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL WATSON PHARMA, INC. 00364220601 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL WATSON PHARMA, INC. 00364220701 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL WATSON PHARMA, INC. 00364220901 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 00364221001 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 00364223601 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL WATSON PHARMA, INC. 00364223701 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL WATSON PHARMA, INC. 00364224301 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL WATSON PHARMA, INC. 00364226501 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL WATSON PHARMA, INC. 00364226601 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL WATSON PHARMA, INC. 00364226701 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL WATSON PHARMA, INC. 00364226801 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL WATSON PHARMA, INC. 00364227877 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL WATSON PHARMA, INC. 00364229401 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL WATSON PHARMA, INC. 00364229501 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL WATSON PHARMA, INC. 00364229601 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL WATSON PHARMA, INC. 00364230001 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL WATSON PHARMA, INC. 00364230301 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 49 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00364230401 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00364230501 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00364230601 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00364231701 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL WATSON PHARMA, INC. 00364231702 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL WATSON PHARMA, INC. 00364243201 AMOXAPINE 25MG TABLET 46083 AMOXAPINE WATSON PHARMA, INC. 00364243301 AMOXAPINE 50MG TABLET 46084 AMOXAPINE WATSON PHARMA, INC. 00364243401 AMOXAPINE 100MG TABLET 46081 AMOXAPINE WATSON PHARMA, INC. 00364243530 AMOXAPINE 150MG TABLET 46082 AMOXAPINE WATSON PHARMA, INC. 00364250801 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364250805 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364250890 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364250901 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364250902 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364250905 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364250990 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364251001 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364251005 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364251090 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364251101 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364251190 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00364252501 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL WATSON PHARMA, INC. 00364258201 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 00364258205 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 00364258301 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 00364258305 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 00364258401 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 00364258405 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 00364262301 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE WATSON PHARMA, INC. 00364262401 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE WATSON PHARMA, INC. 00364262601 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE WATSON PHARMA, INC. 00364666454 CHLORPROMAZINE 25MG/ML VIAL 3790 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00364666854 PROMAZINE 50MG/ML VIAL 3804 PROMAZINE HCL WATSON PHARMA, INC. 00378003001 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MYLAN PHARMACEUTICALS, INC. 00378003005 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MYLAN PHARMACEUTICALS, INC. 00378004001 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MYLAN PHARMACEUTICALS, INC. 00378004005 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MYLAN PHARMACEUTICALS, INC. 00378004201 PERPHEN-AMITRIP 4 MG-10 MG TAB 46185 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378006001 MAPROTILINE 25 MG TABLET 46132 MAPROTILINE HCL MYLAN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 50 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00378007001 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM MYLAN PHARMACEUTICALS, INC. 00378007301 PERPHEN-AMITRIP 4 MG-50 MG TAB 46188 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378008701 MAPROTILINE 50 MG TABLET 46133 MAPROTILINE HCL MYLAN PHARMACEUTICALS, INC. 00378009201 MAPROTILINE 75 MG TABLET 46134 MAPROTILINE HCL MYLAN PHARMACEUTICALS, INC. 00378021101 CHLORDIAZEPO-AMITRIPTYL 5-12.5 46191 AMITRIP HCL/CHLORDIAZEPOXIDEMYLAN PHARMACEUTICALS, INC. 00378021105 CHLORDIAZEPO-AMITRIPTYL 5-12.5 46191 AMITRIP HCL/CHLORDIAZEPOXIDEMYLAN PHARMACEUTICALS, INC. 00378021401 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378021410 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378025701 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378025710 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378027101 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM MYLAN PHARMACEUTICALS, INC. 00378027105 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM MYLAN PHARMACEUTICALS, INC. 00378027701 CHLORDIAZEPOX-AMITRIPTYL 10-25 46192 AMITRIP HCL/CHLORDIAZEPOXIDEMYLAN PHARMACEUTICALS, INC. 00378027705 CHLORDIAZEPOX-AMITRIPTYL 10-25 46192 AMITRIP HCL/CHLORDIAZEPOXIDEMYLAN PHARMACEUTICALS, INC. 00378032101 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378032105 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378032701 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378032710 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378033001 PERPHEN-AMITRIP 2 MG-10 MG TAB 46184 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378033005 PERPHEN-AMITRIP 2 MG-10 MG TAB 46184 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378033401 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378033501 HALOPERIDOL 20 MG TABLET 3976 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378034501 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM MYLAN PHARMACEUTICALS, INC. 00378034505 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM MYLAN PHARMACEUTICALS, INC. 00378035101 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378035110 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL MYLAN PHARMACEUTICALS, INC. 00378040701 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE MYLAN PHARMACEUTICALS, INC. 00378041201 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE MYLAN PHARMACEUTICALS, INC. 00378041401 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE MYLAN PHARMACEUTICALS, INC. 00378043301 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378043305 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378043501 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378043505 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378044201 PERPHEN-AMITRIP 2 MG-25 MG TAB 46186 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378044205 PERPHEN-AMITRIP 2 MG-25 MG TAB 46186 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378045701 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378045705 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378045710 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378047201 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 51 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00378047205 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378047277 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378047301 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378047305 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378047377 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378047701 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM MYLAN PHARMACEUTICALS, INC. 00378047705 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM MYLAN PHARMACEUTICALS, INC. 00378057401 PERPHEN-AMITRIP 4 MG-25 MG TAB 46187 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378057405 PERPHEN-AMITRIP 4 MG-25 MG TAB 46187 PERPHENAZINE/AMITRIPTYLINE HCLMYLAN PHARMACEUTICALS, INC. 00378061201 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378061210 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378061401 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378061410 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378061601 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378061610 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378061801 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378061810 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378077701 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378077705 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378082501 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE MYLAN PHARMACEUTICALS, INC. 00378086001 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE MYLAN PHARMACEUTICALS, INC. 00378086005 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE MYLAN PHARMACEUTICALS, INC. 00378097201 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE MYLAN PHARMACEUTICALS, INC. 00378097301 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE MYLAN PHARMACEUTICALS, INC. 00378097305 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE MYLAN PHARMACEUTICALS, INC. 00378100101 THIOTHIXENE 1 MG CAPSULE 3995 THIOTHIXENE MYLAN PHARMACEUTICALS, INC. 00378101101 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE MYLAN PHARMACEUTICALS, INC. 00378101110 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE MYLAN PHARMACEUTICALS, INC. 00378104301 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378104401 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378104501 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378104505 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378104901 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378104910 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378114001 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC. 00378114005 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC. 00378115001 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC. 00378115005 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC. 00378116505 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 52 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00378116580 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC. 00378116591 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC. 00378117591 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL MYLAN PHARMACEUTICALS, INC. 00378141001 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378192101 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378192201 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378192205 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378192401 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378192405 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378200201 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE MYLAN PHARMACEUTICALS, INC. 00378200210 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE MYLAN PHARMACEUTICALS, INC. 00378200305 PAROXETINE CR 12.5 MG TABLET 50137 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378200393 PAROXETINE CR 12.5 MG TABLET 50137 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378200405 PAROXETINE CR 25 MG TABLET 50136 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378200493 PAROXETINE CR 25 MG TABLET 50136 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378200593 PAROXETINE ER 37.5 MG TABLET 50138 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378200693 PAROXETINE CR 37.5 MG TABLET 50138 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378200877 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378200905 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378205291 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378205391 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378205491 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378205591 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378232101 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378232105 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378232501 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378240101 TRIFLUOPERAZINE 1 MG TABLET 3851 TRIFLUOPERAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378240201 TRIFLUOPERAZINE 2 MG TABLET 3853 TRIFLUOPERAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378240501 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378240505 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378241001 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378241005 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378245701 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378245710 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378261001 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378261010 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378262501 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378262510 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378265001 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 53 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00378265010 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378267501 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378267593 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378268501 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378268593 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378269501 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378269593 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378277701 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378277705 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MYLAN PHARMACEUTICALS, INC. 00378300501 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE MYLAN PHARMACEUTICALS, INC. 00378300510 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE MYLAN PHARMACEUTICALS, INC. 00378302501 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL MYLAN PHARMACEUTICALS, INC. 00378305001 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL MYLAN PHARMACEUTICALS, INC. 00378307501 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL MYLAN PHARMACEUTICALS, INC. 00378312501 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378312510 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378325001 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378341101 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378341105 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378341201 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378341205 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378341301 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378341305 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL MYLAN PHARMACEUTICALS, INC. 00378347101 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378347110 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378347201 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378347210 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378347301 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378347310 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378347401 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL MYLAN PHARMACEUTICALS, INC. 00378350205 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378350291 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378350505 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378350591 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378351105 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378351191 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378351205 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378351291 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378351305 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE MYLAN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 54 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00378351391 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378351491 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378351510 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE MYLAN PHARMACEUTICALS, INC. 00378351593 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE MYLAN PHARMACEUTICALS, INC. 00378353005 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE MYLAN PHARMACEUTICALS, INC. 00378353093 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE MYLAN PHARMACEUTICALS, INC. 00378354505 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE MYLAN PHARMACEUTICALS, INC. 00378354593 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE MYLAN PHARMACEUTICALS, INC. 00378385577 ESCITALOPRAM 5 MG TABLET 51642 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378385593 ESCITALOPRAM 5 MG TABLET 51642 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378385610 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378385677 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378385693 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378385710 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378385777 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378385793 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE MYLAN PHARMACEUTICALS, INC. 00378400101 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400105 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400177 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400301 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400305 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400377 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400501 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400505 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400577 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378400701 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378417501 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL MYLAN PHARMACEUTICALS, INC. 00378418601 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418605 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418693 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418701 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418705 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418793 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418801 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418805 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378418893 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL MYLAN PHARMACEUTICALS, INC. 00378421001 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378422001 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378425001 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 55 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00378425010 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378425101 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378425105 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378425201 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378425205 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378425305 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378425391 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378425405 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378425491 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378435093 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378488101 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378488201 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378488301 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378488401 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378488501 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378501001 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE MYLAN PHARMACEUTICALS, INC. 00378501010 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE MYLAN PHARMACEUTICALS, INC. 00378502191 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378502291 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378502391 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378502491 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM MYLAN PHARMACEUTICALS, INC. 00378513105 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378513205 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378513305 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL MYLAN PHARMACEUTICALS, INC. 00378537501 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378537510 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378541028 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378542028 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378600401 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378600405 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378600901 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378600905 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378604328 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378604393 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378604428 RISPERIDONE 1 MG ODT 51799 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378604493 RISPERIDONE 1 MG ODT 51799 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378604528 RISPERIDONE 2 MG ODT 51800 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378604628 RISPERIDONE 3 MG ODT 59402 RISPERIDONE MYLAN PHARMACEUTICALS, INC. 00378604728 RISPERIDONE 4 MG ODT 59403 RISPERIDONE MYLAN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 56 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00378607401 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378607405 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378609701 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378609705 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL MYLAN PHARMACEUTICALS, INC. 00378623101 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378623105 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378623201 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378623205 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378623301 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378623305 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE MYLAN PHARMACEUTICALS, INC. 00378641001 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378641010 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL MYLAN PHARMACEUTICALS, INC. 00378690501 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378692501 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE MYLAN PHARMACEUTICALS, INC. 00378700110 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700193 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700210 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700293 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700310 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700393 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700410 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700493 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MYLAN PHARMACEUTICALS, INC. 00378700501 LOXAPINE 5 MG CAPSULE 3983 LOXAPINE SUCCINATE MYLAN PHARMACEUTICALS, INC. 00378701001 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE MYLAN PHARMACEUTICALS, INC. 00378702501 LOXAPINE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE MYLAN PHARMACEUTICALS, INC. 00378705001 LOXAPINE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE MYLAN PHARMACEUTICALS, INC. 00378800801 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00378800805 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM MYLAN PHARMACEUTICALS, INC. 00394022260 ST. JOHN'S WORT 150 MG CAP 46331 ST. JOHN'S WORT LABELER NOT ON FILE 00402035082 CHLORPROMAZINE 25MG/ML AMP 3788 CHLORPROMAZINE HCL STERIS LABORATORIES, INC. 00402044510 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM STERIS LABORATORIES, INC. 00403000930 LORAZEPAM 1MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00403000971 LORAZEPAM 1MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00403018230 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 00403078430 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00403078801 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00403078830 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00403078871 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00403079030 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 57 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00403121802 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00403209230 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL LABELER NOT ON FILE 00403212630 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00403222002 DIAZEPAM 10MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00403222030 DIAZEPAM 10MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00403222401 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00403222430 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00403222471 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00403232401 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00403232430 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00403444030 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00405003701 AMITRIP/CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEALIGEN INDEPENDENT LABORATORIES, INC. 00405003801 AMITRIPTYLINE/CDP 25-10 TAB 46192 AMITRIP HCL/CHLORDIAZEPOXIDEALIGEN INDEPENDENT LABORATORIES, INC. 00405004001 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405004101 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405004103 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405004201 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405005001 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALIGEN INDEPENDENT LABORATORIES, INC. 00405005002 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALIGEN INDEPENDENT LABORATORIES, INC. 00405005101 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALIGEN INDEPENDENT LABORATORIES, INC. 00405005102 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALIGEN INDEPENDENT LABORATORIES, INC. 00405005201 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ALIGEN INDEPENDENT LABORATORIES, INC. 00405006801 DIAZEPAM 2MG TABLET 3767 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405006802 DIAZEPAM 2MG TABLET 3767 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405006803 DIAZEPAM 2MG TABLET 3767 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405006901 DIAZEPAM 5MG TABLET 3768 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405006902 DIAZEPAM 5MG TABLET 3768 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405006903 DIAZEPAM 5MG TABLET 3768 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405007001 DIAZEPAM 10MG TABLET 3766 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405007002 DIAZEPAM 10MG TABLET 3766 DIAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405010801 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405010802 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405010901 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405010902 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405011001 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405011002 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405011501 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE ALIGEN INDEPENDENT LABORATORIES, INC. 00405011601 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE ALIGEN INDEPENDENT LABORATORIES, INC. 00405011603 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE ALIGEN INDEPENDENT LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 58 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00405013301 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405013401 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405268076 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405404301 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405404302 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405404401 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405404402 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405404501 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405404502 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ALIGEN INDEPENDENT LABORATORIES, INC. 00405406601 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405406603 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405406701 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405406703 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405406801 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405406803 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405406901 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405407001 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405407101 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405407701 AMOXAPINE 50MG TABLET 46084 AMOXAPINE ALIGEN INDEPENDENT LABORATORIES, INC. 00405407801 AMOXAPINE 100MG TABLET 46081 AMOXAPINE ALIGEN INDEPENDENT LABORATORIES, INC. 00405419601 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405419701 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405419801 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405419901 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405420001 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405430501 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405430601 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405430701 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405436901 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405436903 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405437001 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405437003 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405437101 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405437201 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405437301 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405443901 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405444001 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405444101 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405444201 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 59 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00405445901 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL ALIGEN INDEPENDENT LABORATORIES, INC. 00405446001 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL ALIGEN INDEPENDENT LABORATORIES, INC. 00405446101 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL ALIGEN INDEPENDENT LABORATORIES, INC. 00405446201 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL ALIGEN INDEPENDENT LABORATORIES, INC. 00405446301 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL ALIGEN INDEPENDENT LABORATORIES, INC. 00405446401 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL ALIGEN INDEPENDENT LABORATORIES, INC. 00405453401 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405453501 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405453503 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405453601 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405453603 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405459401 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405470601 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405470701 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405478001 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE ALIGEN INDEPENDENT LABORATORIES, INC. 00405478101 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE ALIGEN INDEPENDENT LABORATORIES, INC. 00405478701 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLALIGEN INDEPENDENT LABORATORIES, INC. 00405478801 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLALIGEN INDEPENDENT LABORATORIES, INC. 00405479001 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLALIGEN INDEPENDENT LABORATORIES, INC. 00405499301 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499303 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499401 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499501 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499503 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499601 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499603 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499701 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499801 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405499901 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405500401 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE ALIGEN INDEPENDENT LABORATORIES, INC. 00405500501 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE ALIGEN INDEPENDENT LABORATORIES, INC. 00405500601 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE ALIGEN INDEPENDENT LABORATORIES, INC. 00405500701 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE ALIGEN INDEPENDENT LABORATORIES, INC. 00405503601 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405503603 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405503701 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405503801 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL ALIGEN INDEPENDENT LABORATORIES, INC. 00405509401 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID ALIGEN INDEPENDENT LABORATORIES, INC. 00405512001 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE ALIGEN INDEPENDENT LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 60 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00405512101 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE ALIGEN INDEPENDENT LABORATORIES, INC. 00405512201 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE ALIGEN INDEPENDENT LABORATORIES, INC. 00405512301 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE ALIGEN INDEPENDENT LABORATORIES, INC. 00406066101 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MALLINCKRODT INC. 00406066105 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MALLINCKRODT INC. 00406066191 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MALLINCKRODT INC. 00406066301 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MALLINCKRODT INC. 00406066303 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MALLINCKRODT INC. 00406066305 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MALLINCKRODT INC. 00406066362 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MALLINCKRODT INC. 00406066363 FLUOXETINE 20MG CAPSULE 46214 FLUOXETINE HCL MALLINCKRODT INC. 00406066391 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MALLINCKRODT INC. 00406066701 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL MALLINCKRODT INC. 00406200103 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MALLINCKRODT INC. 00406200105 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MALLINCKRODT INC. 00406200190 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MALLINCKRODT INC. 00406208001 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL MALLINCKRODT INC. 00406208101 HALOPERIDOL 20 MG TABLET 3976 HALOPERIDOL MALLINCKRODT INC. 00406209703 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MALLINCKRODT INC. 00406209705 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MALLINCKRODT INC. 00406209790 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MALLINCKRODT INC. 00406209801 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MALLINCKRODT INC. 00406209803 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MALLINCKRODT INC. 00406209805 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MALLINCKRODT INC. 00406209890 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MALLINCKRODT INC. 00406209903 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL MALLINCKRODT INC. 00406209905 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL MALLINCKRODT INC. 00406209990 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL MALLINCKRODT INC. 00406990601 ANAFRANIL 25 MG CAPSULE 46120 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406990603 ANAFRANIL 25 MG CAPSULE 46120 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406990662 ANAFRANIL 25 MG CAPSULE 46120 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406990701 ANAFRANIL 50 MG CAPSULE 46121 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406990703 ANAFRANIL 50 MG CAPSULE 46121 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406990762 ANAFRANIL 50 MG CAPSULE 46121 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406990801 ANAFRANIL 75 MG CAPSULE 46122 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406990803 ANAFRANIL 75 MG CAPSULE 46122 CLOMIPRAMINE HCL MALLINCKRODT INC. 00406991001 PAMELOR 10 MG CAPSULE 46059 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406991003 PAMELOR 10 MG CAPSULE 46059 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406991101 PAMELOR 25 MG CAPSULE 46060 NORTRIPTYLINE HCL MALLINCKRODT INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 61 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00406991103 PAMELOR 25 MG CAPSULE 46060 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406991201 PAMELOR 50 MG CAPSULE 46061 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406991203 PAMELOR 50 MG CAPSULE 46061 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406991301 PAMELOR 75 MG CAPSULE 46062 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406991303 PAMELOR 75 MG CAPSULE 46062 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406991816 PAMELOR 10 MG/5 ML SOLUTION 46063 NORTRIPTYLINE HCL MALLINCKRODT INC. 00406992001 TOFRANIL 10 MG TABLET 46068 IMIPRAMINE HCL MALLINCKRODT INC. 00406992003 TOFRANIL 10 MG TABLET 46068 IMIPRAMINE HCL MALLINCKRODT INC. 00406992101 TOFRANIL 25 MG TABLET 46069 IMIPRAMINE HCL MALLINCKRODT INC. 00406992103 TOFRANIL 25 MG TABLET 46069 IMIPRAMINE HCL MALLINCKRODT INC. 00406992201 TOFRANIL 50 MG TABLET 46070 IMIPRAMINE HCL MALLINCKRODT INC. 00406992203 TOFRANIL 50 MG TABLET 46070 IMIPRAMINE HCL MALLINCKRODT INC. 00406992301 TOFRANIL-PM 75 MG CAPSULE 46078 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406992303 TOFRANIL-PM 75 MG CAPSULE 46078 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406992401 TOFRANIL-PM 100 MG CAPSULE 46075 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406992403 TOFRANIL-PM 100 MG CAPSULE 46075 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406992501 TOFRANIL-PM 125 MG CAPSULE 46076 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406992503 TOFRANIL-PM 125 MG CAPSULE 46076 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406992601 TOFRANIL-PM 150 MG CAPSULE 46077 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406992603 TOFRANIL-PM 150 MG CAPSULE 46077 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406993103 IMIPRAMINE PAMOATE 75 MG CAP 46078 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406993203 IMIPRAMINE PAMOATE 100 MG CAP 46075 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406993303 IMIPRAMINE PAMOATE 125 MG CAP 46076 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00406993403 IMIPRAMINE PAMOATE 150 MG CAP 46077 IMIPRAMINE PAMOATE MALLINCKRODT INC. 00409118701 DROPERIDOL 2.5 MG/ML AMPUL 3964 DROPERIDOL HOSPIRA, INC. 00409127305 DIAZEPAM 5 MG/ML SYRINGE 3762 DIAZEPAM HOSPIRA, INC. 00409127332 DIAZEPAM 5 MG/ML SYRINGE 3762 DIAZEPAM HOSPIRA, INC. 00409321302 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM HOSPIRA, INC. 00409321312 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM HOSPIRA, INC. 00418272001 FLUPHENAZINE DEC 25MG/ML VL 3818 FLUPHENAZINE DECANOATE PASADENA RESEARCH LABORATORIES, INC. 00418272010 FLUPHENAZINE DEC 25MG/ML VL 3818 FLUPHENAZINE DECANOATE PASADENA RESEARCH LABORATORIES, INC. 00418272020 FLUPHENAZINE 2.5MG/ML VIAL 3820 FLUPHENAZINE HCL PASADENA RESEARCH LABORATORIES, INC. 00430021014 SARAFEM 10 MG TABLET 46216 FLUOXETINE HCL WARNER CHILCOTT LABORATORIES 00430021514 SARAFEM 15 MG TABLET 65296 FLUOXETINE HCL WARNER CHILCOTT LABORATORIES 00430022014 SARAFEM 20 MG TABLET 46219 FLUOXETINE HCL WARNER CHILCOTT LABORATORIES 00430043514 SARAFEM 10 MG PULVULE 46213 FLUOXETINE HCL WARNER CHILCOTT LABORATORIES 00430043614 SARAFEM 20 MG PULVULE 46214 FLUOXETINE HCL WARNER CHILCOTT LABORATORIES 00440707006 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00440707030 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 62 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00440707060 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00440707090 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 00440707103 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00440707106 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00440707130 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00440707160 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00440707190 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00440707191 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 00440707230 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00440707290 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00440707291 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 00440707360 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 00440707390 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 00440709030 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709130 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709160 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709190 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709191 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709192 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709194 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709199 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709230 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709260 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709290 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709291 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709294 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709330 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440709490 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 00440720330 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 00440720360 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 00440720460 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 00440720630 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 00440720660 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 00440720690 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 00440720730 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 00440720760 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 00440720790 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 00440720830 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 00440720860 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 63 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00440720890 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 00440725030 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725130 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725160 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725190 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725191 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725203 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725206 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725208 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725212 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725215 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725230 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725290 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440725291 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 00440728530 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL LABELER NOT ON FILE 00440728590 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL LABELER NOT ON FILE 00440728630 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL LABELER NOT ON FILE 00440728690 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL LABELER NOT ON FILE 00440729390 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 00440729415 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 00440729430 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 00440729445 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 00440729490 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 00440729590 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 00440730730 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL LABELER NOT ON FILE 00440730830 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL LABELER NOT ON FILE 00440731030 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731090 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731106 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731110 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731120 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731130 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731203 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731206 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731210 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 00440731560 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE LABELER NOT ON FILE 00440731790 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE LABELER NOT ON FILE 00440731791 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE LABELER NOT ON FILE 00440737530 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 64 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00440737603 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737604 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737606 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737610 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737630 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737660 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737690 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737691 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00440737730 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00440737760 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00440737790 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00440737791 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00440737793 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00440747530 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 00440747590 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 00440747630 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 00440747690 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 00440747730 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 00440747790 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 00440747830 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL LABELER NOT ON FILE 00440752107 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00440752114 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00440752128 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00440752130 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00440752160 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00440752190 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 00440753807 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00440753814 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00440753830 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00440753890 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 00440753990 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 00440757560 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL LABELER NOT ON FILE 00440757610 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL LABELER NOT ON FILE 00440757660 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL LABELER NOT ON FILE 00440757690 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL LABELER NOT ON FILE 00440757710 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL LABELER NOT ON FILE 00440757760 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL LABELER NOT ON FILE 00440757790 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL LABELER NOT ON FILE 00440757860 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 65 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00440757890 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL LABELER NOT ON FILE 00440763590 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 00440763690 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 00440769012 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 00440769060 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 00440772006 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00440772014 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00440772015 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00440772030 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00440772060 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00440772090 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 00440772103 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772104 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772106 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772108 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772115 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772130 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772160 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772190 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772191 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 00440772230 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 00440772260 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 00440772290 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 00440782530 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 00440782560 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 00440782590 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 00440782630 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 00440782660 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 00440782690 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 00440782730 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE LABELER NOT ON FILE 00440785560 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL LABELER NOT ON FILE 00440785591 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL LABELER NOT ON FILE 00440785592 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL LABELER NOT ON FILE 00440785660 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL LABELER NOT ON FILE 00440785691 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL LABELER NOT ON FILE 00440785692 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL LABELER NOT ON FILE 00440785760 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL LABELER NOT ON FILE 00440785791 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL LABELER NOT ON FILE 00440785792 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 66 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00440785860 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL LABELER NOT ON FILE 00440785891 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL LABELER NOT ON FILE 00440785892 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL LABELER NOT ON FILE 00440785960 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL LABELER NOT ON FILE 00440785991 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL LABELER NOT ON FILE 00440785992 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL LABELER NOT ON FILE 00440799530 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM LABELER NOT ON FILE 00440799550 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM LABELER NOT ON FILE 00440799560 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM LABELER NOT ON FILE 00440799590 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM LABELER NOT ON FILE 00440799591 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM LABELER NOT ON FILE 00440799630 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM LABELER NOT ON FILE 00440799650 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM LABELER NOT ON FILE 00440799660 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM LABELER NOT ON FILE 00440799690 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM LABELER NOT ON FILE 00440799691 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM LABELER NOT ON FILE 00440799730 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 00440799750 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 00440799760 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 00440799790 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 00440799791 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 00440801030 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 00440801090 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 00440801130 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 00440801190 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 00440801230 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 00440801290 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 00440801315 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 00440801330 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 00440801390 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 00440806060 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 00440806160 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE LABELER NOT ON FILE 00440856190 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE LABELER NOT ON FILE 00440857504 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 00440857520 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 00440857530 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 00440857560 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 00440857590 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 00440857599 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 67 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00440857630 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 00440857660 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 00456111030 VIIBRYD 10 MG TABLET 67376 VILAZODONE HYDROCHLORIDE FOREST LABORATORIES, INC. 00456112030 VIIBRYD 20 MG TABLET 67377 VILAZODONE HYDROCHLORIDE FOREST LABORATORIES, INC. 00456114030 VIIBRYD 40 MG TABLET 67378 VILAZODONE HYDROCHLORIDE FOREST LABORATORIES, INC. 00456200501 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456201001 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456201011 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456201063 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456202001 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456202011 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456202063 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456210108 LEXAPRO 5 MG/5 ML SOLUTION 51698 ESCITALOPRAM OXALATE FOREST LABORATORIES, INC. 00456401001 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE FOREST LABORATORIES, INC. 00456402001 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE FOREST LABORATORIES, INC. 00456402063 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE FOREST LABORATORIES, INC. 00456404001 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE FOREST LABORATORIES, INC. 00456404063 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE FOREST LABORATORIES, INC. 00456413004 CELEXA 10MG/5ML SOLUTION 46205 CITALOPRAM HYDROBROMIDE FOREST LABORATORIES, INC. 00456413008 CELEXA 10 MG/5 ML SOLUTION 46205 CITALOPRAM HYDROBROMIDE FOREST LABORATORIES, INC. 00469272020 FLUPHENAZINE DEC 25MG/ML VL 3818 FLUPHENAZINE DECANOATE ASTELLAS PHARMA US, INC. 00469281030 FLUPHENAZINE 2.5MG/ML VIAL 3820 FLUPHENAZINE HCL ASTELLAS PHARMA US, INC. 00469436901 HALOPERIDOL DEC 50MG/ML VL 3967 HALOPERIDOL DECANOATE ASTELLAS PHARMA US, INC. 00469436905 HALOPERIDOL DEC 50MG/ML VL 3967 HALOPERIDOL DECANOATE ASTELLAS PHARMA US, INC. 00469437105 HALOPERIDOL DEC 100MG/ML VL 11876 HALOPERIDOL DECANOATE ASTELLAS PHARMA US, INC. 00472002104 FLUOXETINE 20MG/5ML SOLN 46217 FLUOXETINE HCL ACTAVIS 00472004950 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ACTAVIS 00472021016 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM ACTAVIS 00472025116 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM ACTAVIS 00472074298 CHLORPROMAZINE 100 MG/ML CON 3794 CHLORPROMAZINE HCL ACTAVIS 00472076694 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE ACTAVIS 00472076699 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE ACTAVIS 00472145194 THIORIDAZINE 100MG/ML CONC 3857 THIORIDAZINE HCL ACTAVIS 00472145791 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL ACTAVIS 00472145794 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL ACTAVIS 00490009100 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE SOUTHWOOD PHARM 00490009130 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE SOUTHWOOD PHARM 00490009160 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE SOUTHWOOD PHARM 00490009190 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 68 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00517970210 DROPERIDOL 2.5MG/ML VIAL 3965 DROPERIDOL AMERICAN REGENT LABORATORIES, INC. 00517970225 DROPERIDOL 2.5 MG/ML VIAL 3965 DROPERIDOL AMERICAN REGENT LABORATORIES, INC. 00517970510 DROPERIDOL 2.5MG/ML VIAL 3965 DROPERIDOL AMERICAN REGENT LABORATORIES, INC. 00517971010 DROPERIDOL 2.5MG/ML VIAL 3965 DROPERIDOL AMERICAN REGENT LABORATORIES, INC. 00527139401 LOXAPINE 5 MG CAPSULE 3983 LOXAPINE SUCCINATE LANNETT COMPANY, INC. 00527139501 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE LANNETT COMPANY, INC. 00527139601 LOXAPINE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE LANNETT COMPANY, INC. 00527139701 LOXAPINE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE LANNETT COMPANY, INC. 00527178801 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00527178805 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00527178901 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00527178905 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00527179001 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00527179005 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00527179101 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00527179105 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL LANNETT COMPANY, INC. 00536068597 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL WATSON PHARMA, INC. 00536101197 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE WATSON PHARMA, INC. 00536214097 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL WATSON PHARMA, INC. 00536220097 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL WATSON PHARMA, INC. 00536239085 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM WATSON PHARMA, INC. 00536300301 AMOXAPINE 25MG TABLET 46083 AMOXAPINE WATSON PHARMA, INC. 00536300401 AMOXAPINE 50MG TABLET 46084 AMOXAPINE WATSON PHARMA, INC. 00536300501 AMOXAPINE 100MG TABLET 46081 AMOXAPINE WATSON PHARMA, INC. 00536300607 AMOXAPINE 150MG TABLET 46082 AMOXAPINE WATSON PHARMA, INC. 00536307101 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307110 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307201 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307210 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307301 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307305 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307310 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307401 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307405 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307501 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307505 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307601 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL WATSON PHARMA, INC. 00536307701 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 00536307705 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 69 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00536307801 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 00536308201 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 00536308205 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 00536308301 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 00536308305 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 00536323501 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 00536323505 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 00536323510 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 00536323601 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 00536323605 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 00536323610 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 00536323701 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 00536323705 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 00536323801 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM WATSON PHARMA, INC. 00536348701 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536348705 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536348710 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536348801 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536348805 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536348810 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536348901 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536348905 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00536359101 DIAZEPAM 2MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00536359105 DIAZEPAM 2MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00536359110 DIAZEPAM 2MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00536359201 DIAZEPAM 5MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00536359205 DIAZEPAM 5MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00536359210 DIAZEPAM 5MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00536359301 DIAZEPAM 10MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00536359305 DIAZEPAM 10MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00536359310 DIAZEPAM 10MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00536373701 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL WATSON PHARMA, INC. 00536373705 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL WATSON PHARMA, INC. 00536373801 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL WATSON PHARMA, INC. 00536373901 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE WATSON PHARMA, INC. 00536373905 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE WATSON PHARMA, INC. 00536373910 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE WATSON PHARMA, INC. 00536380501 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL WATSON PHARMA, INC. 00536380601 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 70 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00536380701 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL WATSON PHARMA, INC. 00536380801 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL WATSON PHARMA, INC. 00536385070 CHLORPROMAZINE 25MG/ML VIAL 3790 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536386901 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL WATSON PHARMA, INC. 00536386905 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL WATSON PHARMA, INC. 00536387701 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL WATSON PHARMA, INC. 00536387705 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL WATSON PHARMA, INC. 00536387801 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL WATSON PHARMA, INC. 00536387805 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL WATSON PHARMA, INC. 00536387901 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL WATSON PHARMA, INC. 00536387905 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL WATSON PHARMA, INC. 00536388001 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL WATSON PHARMA, INC. 00536388005 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL WATSON PHARMA, INC. 00536390201 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL WATSON PHARMA, INC. 00536390301 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL WATSON PHARMA, INC. 00536392901 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL WATSON PHARMA, INC. 00536392910 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL WATSON PHARMA, INC. 00536393001 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL WATSON PHARMA, INC. 00536393010 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL WATSON PHARMA, INC. 00536393101 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL WATSON PHARMA, INC. 00536393110 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL WATSON PHARMA, INC. 00536400501 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE WATSON PHARMA, INC. 00536400510 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE WATSON PHARMA, INC. 00536400601 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 00536400610 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 00536413101 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE WATSON PHARMA, INC. 00536413201 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE WATSON PHARMA, INC. 00536413301 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE WATSON PHARMA, INC. 00536413302 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE WATSON PHARMA, INC. 00536413401 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE WATSON PHARMA, INC. 00536420070 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM WATSON PHARMA, INC. 00536447701 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID WATSON PHARMA, INC. 00536451601 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE WATSON PHARMA, INC. 00536451605 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE WATSON PHARMA, INC. 00536456301 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL WATSON PHARMA, INC. 00536456310 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL WATSON PHARMA, INC. 00536456401 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 00536456410 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 00536456501 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 71 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00536456510 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC. 00536456601 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL WATSON PHARMA, INC. 00536456610 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL WATSON PHARMA, INC. 00536464101 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464110 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464201 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464210 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464301 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464305 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464310 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464401 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464405 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464901 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL WATSON PHARMA, INC. 00536464905 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL WATSON PHARMA, INC. 00536465401 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL WATSON PHARMA, INC. 00536468801 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL WATSON PHARMA, INC. 00536468802 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL WATSON PHARMA, INC. 00536468805 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL WATSON PHARMA, INC. 00536468901 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL WATSON PHARMA, INC. 00536468902 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL WATSON PHARMA, INC. 00536469101 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL WATSON PHARMA, INC. 00536469102 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL WATSON PHARMA, INC. 00536471501 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL WATSON PHARMA, INC. 00536471502 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL WATSON PHARMA, INC. 00536471505 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL WATSON PHARMA, INC. 00536477401 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 00536477405 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 00536477501 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 00536477505 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 00536477601 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL WATSON PHARMA, INC. 00536483401 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00536483501 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00536483601 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00536487701 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM WATSON PHARMA, INC. 00536487705 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM WATSON PHARMA, INC. 00536487801 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM WATSON PHARMA, INC. 00536487901 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM WATSON PHARMA, INC. 00536488101 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 00536488105 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 72 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00536488201 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 00536488205 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 00536488301 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL WATSON PHARMA, INC. 00536488401 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL WATSON PHARMA, INC. 00536490301 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536490310 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536490601 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536490610 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536491501 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536491510 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536491601 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536491610 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536491801 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536491810 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL WATSON PHARMA, INC. 00536494001 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00536494005 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00536494101 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00536494105 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00536494610 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL WATSON PHARMA, INC. 00536494710 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL WATSON PHARMA, INC. 00536495101 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE WATSON PHARMA, INC. 00536495201 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE WATSON PHARMA, INC. 00536495205 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE WATSON PHARMA, INC. 00536495401 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE WATSON PHARMA, INC. 00536495405 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE WATSON PHARMA, INC. 00536495801 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL WATSON PHARMA, INC. 00536559501 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00536559601 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 00536559605 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 00536559701 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 00536559705 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 00536559801 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 00536559805 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 00536559901 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM WATSON PHARMA, INC. 00536571601 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00536571701 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00536571901 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00555003302 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL BARR LABORATORIES INC 00555003305 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL BARR LABORATORIES INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 73 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00555015802 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL BARR LABORATORIES INC 00555015804 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL BARR LABORATORIES INC 00555015902 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL BARR LABORATORIES INC 00555015904 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL BARR LABORATORIES INC 00555016302 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM BARR LABORATORIES INC 00555016305 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM BARR LABORATORIES INC 00555016402 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM BARR LABORATORIES INC 00555016405 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM BARR LABORATORIES INC 00555020101 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL BARR LABORATORIES INC 00555024171 MIRTAZAPINE 15 MG RPD DISLV TB 47453 MIRTAZAPINE BARR LABORATORIES INC 00555024271 MIRTAZAPINE 30 MG RPD DISLV TB 47454 MIRTAZAPINE BARR LABORATORIES INC 00555034502 LITHIUM ER 300 MG TABLET 4004 LITHIUM CARBONATE BARR LABORATORIES INC 00555036302 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM BARR LABORATORIES INC 00555036305 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM BARR LABORATORIES INC 00555048902 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL BARR LABORATORIES INC 00555048904 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL BARR LABORATORIES INC 00555049002 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL BARR LABORATORIES INC 00555049004 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL BARR LABORATORIES INC 00555049109 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM BARR LABORATORIES INC 00555049209 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM BARR LABORATORIES INC 00555049309 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM BARR LABORATORIES INC 00555049409 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM BARR LABORATORIES INC 00555059402 PROTRIPTYLINE HCL 10 MG TABLET 46079 PROTRIPTYLINE HCL BARR LABORATORIES INC 00555059502 PROTRIPTYLINE HCL 5 MG TABLET 46080 PROTRIPTYLINE HCL BARR LABORATORIES INC 00555073202 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL BARR LABORATORIES INC 00555073204 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL BARR LABORATORIES INC 00555073302 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL BARR LABORATORIES INC 00555087154 FLUOXETINE DR 90 MG CAPSULE 47571 FLUOXETINE HCL BARR LABORATORIES INC 00555087188 FLUOXETINE DR 90 MG CAPSULE 47571 FLUOXETINE HCL BARR LABORATORIES INC 00555087602 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL BARR LABORATORIES INC 00555087702 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL BARR LABORATORIES INC 00555087704 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL BARR LABORATORIES INC 00555087705 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL BARR LABORATORIES INC 00555087707 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL BARR LABORATORIES INC 00555096702 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE BARR LABORATORIES INC 00555096802 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE BARR LABORATORIES INC 00555096902 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE BARR LABORATORIES INC 00555177104 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE BARR LABORATORIES INC 00555177109 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE BARR LABORATORIES INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 74 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00555177204 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE BARR LABORATORIES INC 00555177209 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE BARR LABORATORIES INC 00555177304 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE BARR LABORATORIES INC 00555177309 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE BARR LABORATORIES INC 00555177409 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE BARR LABORATORIES INC 00555724371 MIRTAZAPINE 45 MG ODT 47636 MIRTAZAPINE BARR LABORATORIES INC 00574016330 LORAZEPAM 2 MG/ML ORAL CONCENT 16363 LORAZEPAM PADDOCK LABORATORIES, INC. 00591024001 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 00591024005 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 00591024010 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 00591024101 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 00591024105 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 00591024110 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 00591024201 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 00591024205 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 00591024210 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 00591036301 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00591036305 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00591036401 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00591036405 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00591036501 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 00591036901 LOXAPINE 5 MG CAPSULE 3983 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00591037001 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00591037101 LOXAPINE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00591037201 LOXAPINE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE WATSON PHARMA, INC. 00591037901 AMOXAPINE 25 MG TABLET 46083 AMOXAPINE WATSON PHARMA, INC. 00591038101 AMOXAPINE 100MG TABLET 46081 AMOXAPINE WATSON PHARMA, INC. 00591038230 AMOXAPINE 150MG TABLET 46082 AMOXAPINE WATSON PHARMA, INC. 00591042616 VALPROIC ACID 250 MG/5 ML SOLN 4535 VALPROATE SODIUM WATSON PHARMA, INC. 00591054501 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL WATSON PHARMA, INC. 00591059401 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL WATSON PHARMA, INC. 00591059501 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL WATSON PHARMA, INC. 00591059601 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL WATSON PHARMA, INC. 00591065701 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL WATSON PHARMA, INC. 00591065705 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL WATSON PHARMA, INC. 00591065710 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL WATSON PHARMA, INC. 00591065801 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL WATSON PHARMA, INC. 00591065805 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL WATSON PHARMA, INC. 00591065810 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 75 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00591071805 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL WATSON PHARMA, INC. 00591071818 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL WATSON PHARMA, INC. 00591071860 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL WATSON PHARMA, INC. 00591076460 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL WATSON PHARMA, INC. 00591076560 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL WATSON PHARMA, INC. 00591076660 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL WATSON PHARMA, INC. 00591076760 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL WATSON PHARMA, INC. 00591078501 CHLORDIAZEPOXIDE 5 MG CAP 3736 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00591078505 CHLORDIAZEPOXIDE 5 MG CAP 3736 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00591078601 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00591078605 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00591078610 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00591078701 CHLORDIAZEPOXIDE 25 MG CAP 3735 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00591078705 CHLORDIAZEPOXIDE 25 MG CAP 3735 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 00591080801 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 00591080805 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 00591080901 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 00591080905 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 00591082601 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL WATSON PHARMA, INC. 00591082610 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL WATSON PHARMA, INC. 00591082701 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL WATSON PHARMA, INC. 00591082710 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL WATSON PHARMA, INC. 00591082730 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL WATSON PHARMA, INC. 00591082790 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL WATSON PHARMA, INC. 00591083925 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL WATSON PHARMA, INC. 00591083960 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL WATSON PHARMA, INC. 00591085860 BUPROPION HCL SR 100 MG TAB 46239 BUPROPION HCL WATSON PHARMA, INC. 00591111710 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE WATSON PHARMA, INC. 00591111730 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE WATSON PHARMA, INC. 00591111810 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE WATSON PHARMA, INC. 00591111830 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE WATSON PHARMA, INC. 00591111930 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE WATSON PHARMA, INC. 00591223015 MIRTAZAPINE 15 MG ODT 47453 MIRTAZAPINE WATSON PHARMA, INC. 00591223115 MIRTAZAPINE 30 MG ODT 47454 MIRTAZAPINE WATSON PHARMA, INC. 00591230001 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL WATSON PHARMA, INC. 00591317601 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE WATSON PHARMA, INC. 00591317605 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE WATSON PHARMA, INC. 00591317701 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE WATSON PHARMA, INC. 00591317705 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 76 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00591317801 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE WATSON PHARMA, INC. 00591317805 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE WATSON PHARMA, INC. 00591323819 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL WATSON PHARMA, INC. 00591323830 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL WATSON PHARMA, INC. 00591323910 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WATSON PHARMA, INC. 00591323919 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WATSON PHARMA, INC. 00591323930 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WATSON PHARMA, INC. 00591324010 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WATSON PHARMA, INC. 00591324019 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WATSON PHARMA, INC. 00591324030 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WATSON PHARMA, INC. 00591333105 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL WATSON PHARMA, INC. 00591333119 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL WATSON PHARMA, INC. 00591333130 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL WATSON PHARMA, INC. 00591333205 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL WATSON PHARMA, INC. 00591333230 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL WATSON PHARMA, INC. 00591338560 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL WATSON PHARMA, INC. 00591354005 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL WATSON PHARMA, INC. 00591354060 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL WATSON PHARMA, INC. 00591354105 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL WATSON PHARMA, INC. 00591354125 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL WATSON PHARMA, INC. 00591354160 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL WATSON PHARMA, INC. 00591354260 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL WATSON PHARMA, INC. 00591401201 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID WATSON PHARMA, INC. 00591523801 MEPROBAMATE 400 MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 00591523810 MEPROBAMATE 400 MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 00591523901 MEPROBAMATE 200 MG TABLET 3713 MEPROBAMATE WATSON PHARMA, INC. 00591523910 MEPROBAMATE 200 MG TABLET 3713 MEPROBAMATE WATSON PHARMA, INC. 00591559901 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL WATSON PHARMA, INC. 00591559910 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL WATSON PHARMA, INC. 00591560001 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL WATSON PHARMA, INC. 00591560010 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL WATSON PHARMA, INC. 00591561901 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00591561905 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00591561910 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM WATSON PHARMA, INC. 00591562001 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00591562005 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00591562010 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM WATSON PHARMA, INC. 00591562101 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00591562105 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 77 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00591562110 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM WATSON PHARMA, INC. 00591562501 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 00591562901 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL WATSON PHARMA, INC. 00591563001 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 00591563010 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 00591563101 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC. 00591563110 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC. 00591563201 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL WATSON PHARMA, INC. 00591563301 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL WATSON PHARMA, INC. 00591571301 AMOXAPINE 25 MG TABLET 46083 AMOXAPINE WATSON PHARMA, INC. 00591571401 AMOXAPINE 50 MG TABLET 46084 AMOXAPINE WATSON PHARMA, INC. 00591571501 AMOXAPINE 100 MG TABLET 46081 AMOXAPINE WATSON PHARMA, INC. 00591571630 AMOXAPINE 150 MG TABLET 46082 AMOXAPINE WATSON PHARMA, INC. 00591578601 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00591578605 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00591578701 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00591578705 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00591578710 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00591578801 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00591578805 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00591578901 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL WATSON PHARMA, INC. 00597002001 SERENTIL 10MG TABLET 3885 MESORIDAZINE BESYLATE BOEHRINGER INGELHEIM PHARMACEUTICALS 00597002101 SERENTIL 25 MG TABLET 3887 MESORIDAZINE BESYLATE BOEHRINGER INGELHEIM PHARMACEUTICALS 00597002201 SERENTIL 50MG TABLET 3888 MESORIDAZINE BESYLATE BOEHRINGER INGELHEIM PHARMACEUTICALS 00597002301 SERENTIL 100 MG TABLET 3886 MESORIDAZINE BESYLATE BOEHRINGER INGELHEIM PHARMACEUTICALS 00597002504 SERENTIL 25 MG/ML ORAL CONC 3884 MESORIDAZINE BESYLATE BOEHRINGER INGELHEIM PHARMACEUTICALS 00597002702 SERENTIL 25MG/ML AMPUL 3883 MESORIDAZINE BESYLATE BOEHRINGER INGELHEIM PHARMACEUTICALS 00603129054 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE QUALITEST PHARMACEUTICALS, INC. 00603141058 LITHIUM CIT 8MEQ/5ML SYRUP 4006 LITHIUM CITRATE QUALITEST PHARMACEUTICALS, INC. 00603175654 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603176254 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL QUALITEST PHARMACEUTICALS, INC. 00603184058 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM QUALITEST PHARMACEUTICALS, INC. 00603184158 VALPROIC ACID 250 MG/5 ML SOLN 4535 VALPROATE SODIUM QUALITEST PHARMACEUTICALS, INC. 00603212721 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603212728 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603212732 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603212821 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603212828 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603212832 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 78 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00603212921 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603212928 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603212932 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603213021 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603213028 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603213120 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603213220 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603213320 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603213420 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603221202 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221216 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221221 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221232 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221321 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221330 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221332 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221421 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221432 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221521 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221621 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603221721 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603224021 AMOXAPINE 25MG TABLET 46083 AMOXAPINE QUALITEST PHARMACEUTICALS, INC. 00603224121 AMOXAPINE 50MG TABLET 46084 AMOXAPINE QUALITEST PHARMACEUTICALS, INC. 00603224221 AMOXAPINE 100MG TABLET 46081 AMOXAPINE QUALITEST PHARMACEUTICALS, INC. 00603224316 AMOXAPINE 150MG TABLET 46082 AMOXAPINE QUALITEST PHARMACEUTICALS, INC. 00603234621 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603234628 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603234721 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603234728 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603234821 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603234828 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM QUALITEST PHARMACEUTICALS, INC. 00603266621 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL QUALITEST PHARMACEUTICALS, INC. 00603266721 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL QUALITEST PHARMACEUTICALS, INC. 00603266732 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL QUALITEST PHARMACEUTICALS, INC. 00603266821 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL QUALITEST PHARMACEUTICALS, INC. 00603266828 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL QUALITEST PHARMACEUTICALS, INC. 00603269021 AMITRIP/CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEQUALITEST PHARMACEUTICALS, INC. 00603269028 AMITRIP/CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEQUALITEST PHARMACEUTICALS, INC. 00603269121 AMITRIP/CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEQUALITEST PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 79 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00603269128 AMITRIP/CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEQUALITEST PHARMACEUTICALS, INC. 00603280821 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603280832 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603280921 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603280932 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603281021 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603281121 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603281132 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603281221 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603300421 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM QUALITEST PHARMACEUTICALS, INC. 00603300428 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM QUALITEST PHARMACEUTICALS, INC. 00603300521 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM QUALITEST PHARMACEUTICALS, INC. 00603300528 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM QUALITEST PHARMACEUTICALS, INC. 00603300621 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM QUALITEST PHARMACEUTICALS, INC. 00603316621 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603316632 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603316721 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603316821 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603321316 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321320 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321321 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321328 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321402 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321416 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321420 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321421 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321422 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321428 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321432 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321502 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321516 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321520 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321521 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321522 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321528 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321532 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321628 DIAZEPAM 2MG TABLET 3767 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321728 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603321828 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITEST PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 80 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00603344121 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM QUALITEST PHARMACEUTICALS, INC. 00603344125 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM QUALITEST PHARMACEUTICALS, INC. 00603344221 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM QUALITEST PHARMACEUTICALS, INC. 00603344228 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM QUALITEST PHARMACEUTICALS, INC. 00603344321 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM QUALITEST PHARMACEUTICALS, INC. 00603344328 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM QUALITEST PHARMACEUTICALS, INC. 00603345521 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345532 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345621 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345632 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345721 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345732 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345821 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345832 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603345921 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603346021 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL QUALITEST PHARMACEUTICALS, INC. 00603366621 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603366721 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603366821 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603366828 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603366921 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603378221 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL QUALITEST PHARMACEUTICALS, INC. 00603378232 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL QUALITEST PHARMACEUTICALS, INC. 00603378332 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL QUALITEST PHARMACEUTICALS, INC. 00603378432 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL QUALITEST PHARMACEUTICALS, INC. 00603378628 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL QUALITEST PHARMACEUTICALS, INC. 00603404321 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603404332 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603404421 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603404432 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603404521 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603404532 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL QUALITEST PHARMACEUTICALS, INC. 00603424321 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603424328 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603424421 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603424428 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603424432 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603424521 LORAZEPAM 2MG TABLET 3759 LORAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603424528 LORAZEPAM 2MG TABLET 3759 LORAZEPAM QUALITEST PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 81 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00603424532 LORAZEPAM 2MG TABLET 3759 LORAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603429421 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL QUALITEST PHARMACEUTICALS, INC. 00603429521 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL QUALITEST PHARMACEUTICALS, INC. 00603429621 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL QUALITEST PHARMACEUTICALS, INC. 00603443921 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE QUALITEST PHARMACEUTICALS, INC. 00603444021 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE QUALITEST PHARMACEUTICALS, INC. 00603444032 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE QUALITEST PHARMACEUTICALS, INC. 00603479821 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603479921 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603480021 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603480121 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603495021 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603495121 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603495221 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM QUALITEST PHARMACEUTICALS, INC. 00603506028 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603506121 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603506128 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603509021 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603509028 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603509121 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603509128 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603509221 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603509228 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603509321 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE QUALITEST PHARMACEUTICALS, INC. 00603511521 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511528 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511621 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511628 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511721 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511728 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511821 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511828 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603511921 AMITRIP/PERPHEN 50-4 TABLET 46188 PERPHENAZINE/AMITRIPTYLINE HCLQUALITEST PHARMACEUTICALS, INC. 00603553121 PROTRIPTYLINE 5MG TABLET 46080 PROTRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603553221 PROTRIPTYLINE 10MG TABLET 46079 PROTRIPTYLINE HCL QUALITEST PHARMACEUTICALS, INC. 00603568320 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568328 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568420 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568428 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE QUALITEST PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 82 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00603568432 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568520 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568528 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568532 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568620 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568628 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568632 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568820 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568828 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568920 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603568928 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00603599221 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603599321 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603599332 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603599421 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603599432 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603599521 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL QUALITEST PHARMACEUTICALS, INC. 00603601821 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE QUALITEST PHARMACEUTICALS, INC. 00603601921 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE QUALITEST PHARMACEUTICALS, INC. 00603602021 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE QUALITEST PHARMACEUTICALS, INC. 00603602121 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE QUALITEST PHARMACEUTICALS, INC. 00603614421 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614428 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614521 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614528 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614621 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614721 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614732 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614821 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614832 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603614921 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615016 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615021 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615025 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615121 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615125 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615621 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615721 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC. 00603615725 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL QUALITEST PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 83 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00603616002 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616013 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616016 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616020 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616021 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616028 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616032 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616102 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616104 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616116 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616120 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616121 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616128 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603616132 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL QUALITEST PHARMACEUTICALS, INC. 00603633421 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID QUALITEST PHARMACEUTICALS, INC. 00603942445 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE QUALITEST PHARMACEUTICALS, INC. 00615034713 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE VANGARD LABS, INC. 00615039513 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL VANGARD LABS, INC. 00615039613 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL VANGARD LABS, INC. 00615039713 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL VANGARD LABS, INC. 00615039813 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL VANGARD LABS, INC. 00615039913 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL VANGARD LABS, INC. 00615040113 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM VANGARD LABS, INC. 00615040129 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM VANGARD LABS, INC. 00615040143 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM VANGARD LABS, INC. 00615040153 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM VANGARD LABS, INC. 00615040163 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM VANGARD LABS, INC. 00615040165 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM VANGARD LABS, INC. 00615040313 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM VANGARD LABS, INC. 00615040353 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM VANGARD LABS, INC. 00615040363 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM VANGARD LABS, INC. 00615040365 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM VANGARD LABS, INC. 00615040913 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM VANGARD LABS, INC. 00615041013 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM VANGARD LABS, INC. 00615041113 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM VANGARD LABS, INC. 00615042613 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM VANGARD LABS, INC. 00615042629 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM VANGARD LABS, INC. 00615042643 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM VANGARD LABS, INC. 00615042653 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM VANGARD LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 84 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00615042663 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM VANGARD LABS, INC. 00615042665 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM VANGARD LABS, INC. 00615043553 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043563 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043565 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043653 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043663 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043665 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043753 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043763 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615043765 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL VANGARD LABS, INC. 00615044713 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE VANGARD LABS, INC. 00615045013 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM VANGARD LABS, INC. 00615045029 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM VANGARD LABS, INC. 00615045043 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM VANGARD LABS, INC. 00615045047 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM VANGARD LABS, INC. 00615045053 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM VANGARD LABS, INC. 00615045063 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM VANGARD LABS, INC. 00615045113 LORAZEPAM 1MG TABLET 3758 LORAZEPAM VANGARD LABS, INC. 00615045129 LORAZEPAM 1MG TABLET 3758 LORAZEPAM VANGARD LABS, INC. 00615045143 LORAZEPAM 1MG TABLET 3758 LORAZEPAM VANGARD LABS, INC. 00615045147 LORAZEPAM 1MG TABLET 3758 LORAZEPAM VANGARD LABS, INC. 00615045153 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM VANGARD LABS, INC. 00615045163 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM VANGARD LABS, INC. 00615045213 LORAZEPAM 2MG TABLET 3759 LORAZEPAM VANGARD LABS, INC. 00615045229 LORAZEPAM 2MG TABLET 3759 LORAZEPAM VANGARD LABS, INC. 00615045243 LORAZEPAM 2MG TABLET 3759 LORAZEPAM VANGARD LABS, INC. 00615045247 LORAZEPAM 2MG TABLET 3759 LORAZEPAM VANGARD LABS, INC. 00615045253 LORAZEPAM 2MG TABLET 3759 LORAZEPAM VANGARD LABS, INC. 00615045263 LORAZEPAM 2MG TABLET 3759 LORAZEPAM VANGARD LABS, INC. 00615052813 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL VANGARD LABS, INC. 00615052913 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL VANGARD LABS, INC. 00615053013 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL VANGARD LABS, INC. 00615082813 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082829 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082843 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082853 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082863 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082865 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL VANGARD LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 85 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00615082913 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082929 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082943 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082953 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082963 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615082965 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615083013 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615083113 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615083213 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL VANGARD LABS, INC. 00615130213 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE VANGARD LABS, INC. 00615130313 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE VANGARD LABS, INC. 00615130413 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE VANGARD LABS, INC. 00615130629 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130643 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130653 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130663 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130665 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130688 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130729 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130743 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130753 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130763 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130765 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615130788 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615131129 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE VANGARD LABS, INC. 00615131143 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE VANGARD LABS, INC. 00615131153 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE VANGARD LABS, INC. 00615131163 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE VANGARD LABS, INC. 00615131529 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615131543 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615131553 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615131563 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615131565 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615131588 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL VANGARD LABS, INC. 00615132529 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID VANGARD LABS, INC. 00615132543 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID VANGARD LABS, INC. 00615132553 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID VANGARD LABS, INC. 00615132563 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID VANGARD LABS, INC. 00615132565 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID VANGARD LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 86 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00615150113 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL VANGARD LABS, INC. 00615150129 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL VANGARD LABS, INC. 00615150143 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL VANGARD LABS, INC. 00615150153 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL VANGARD LABS, INC. 00615150163 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL VANGARD LABS, INC. 00615150165 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL VANGARD LABS, INC. 00615150188 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL VANGARD LABS, INC. 00615150329 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615150343 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615150353 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615150363 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615150365 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615153213 DIAZEPAM 2MG TABLET 3767 DIAZEPAM VANGARD LABS, INC. 00615153229 DIAZEPAM 2MG TABLET 3767 DIAZEPAM VANGARD LABS, INC. 00615153243 DIAZEPAM 2MG TABLET 3767 DIAZEPAM VANGARD LABS, INC. 00615153247 DIAZEPAM 2MG TABLET 3767 DIAZEPAM VANGARD LABS, INC. 00615153253 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM VANGARD LABS, INC. 00615153263 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM VANGARD LABS, INC. 00615153313 DIAZEPAM 5MG TABLET 3768 DIAZEPAM VANGARD LABS, INC. 00615153329 DIAZEPAM 5MG TABLET 3768 DIAZEPAM VANGARD LABS, INC. 00615153343 DIAZEPAM 5MG TABLET 3768 DIAZEPAM VANGARD LABS, INC. 00615153347 DIAZEPAM 5MG TABLET 3768 DIAZEPAM VANGARD LABS, INC. 00615153353 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM VANGARD LABS, INC. 00615153363 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM VANGARD LABS, INC. 00615153413 DIAZEPAM 10MG TABLET 3766 DIAZEPAM VANGARD LABS, INC. 00615153447 DIAZEPAM 10MG TABLET 3766 DIAZEPAM VANGARD LABS, INC. 00615250413 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL VANGARD LABS, INC. 00615250429 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL VANGARD LABS, INC. 00615250443 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL VANGARD LABS, INC. 00615250453 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL VANGARD LABS, INC. 00615250463 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL VANGARD LABS, INC. 00615250465 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL VANGARD LABS, INC. 00615250488 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL VANGARD LABS, INC. 00615250529 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL VANGARD LABS, INC. 00615250543 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL VANGARD LABS, INC. 00615250553 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL VANGARD LABS, INC. 00615250563 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL VANGARD LABS, INC. 00615250565 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL VANGARD LABS, INC. 00615250588 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL VANGARD LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 87 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00615250613 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL VANGARD LABS, INC. 00615250629 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL VANGARD LABS, INC. 00615250643 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL VANGARD LABS, INC. 00615250653 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL VANGARD LABS, INC. 00615250663 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL VANGARD LABS, INC. 00615250665 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL VANGARD LABS, INC. 00615250688 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL VANGARD LABS, INC. 00615250713 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL VANGARD LABS, INC. 00615250729 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL VANGARD LABS, INC. 00615250743 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL VANGARD LABS, INC. 00615250753 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL VANGARD LABS, INC. 00615250763 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL VANGARD LABS, INC. 00615250765 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL VANGARD LABS, INC. 00615250788 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL VANGARD LABS, INC. 00615250813 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL VANGARD LABS, INC. 00615250829 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL VANGARD LABS, INC. 00615250843 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL VANGARD LABS, INC. 00615250853 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL VANGARD LABS, INC. 00615250863 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL VANGARD LABS, INC. 00615250865 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL VANGARD LABS, INC. 00615250888 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL VANGARD LABS, INC. 00615250929 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL VANGARD LABS, INC. 00615250943 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL VANGARD LABS, INC. 00615250953 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL VANGARD LABS, INC. 00615250963 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL VANGARD LABS, INC. 00615250965 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL VANGARD LABS, INC. 00615250988 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL VANGARD LABS, INC. 00615251029 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL VANGARD LABS, INC. 00615251043 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL VANGARD LABS, INC. 00615251053 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL VANGARD LABS, INC. 00615251063 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL VANGARD LABS, INC. 00615251065 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL VANGARD LABS, INC. 00615251088 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL VANGARD LABS, INC. 00615257813 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL VANGARD LABS, INC. 00615257829 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL VANGARD LABS, INC. 00615257843 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL VANGARD LABS, INC. 00615257853 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL VANGARD LABS, INC. 00615257863 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL VANGARD LABS, INC. 00615257865 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL VANGARD LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 88 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00615257913 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL VANGARD LABS, INC. 00615257929 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL VANGARD LABS, INC. 00615257943 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL VANGARD LABS, INC. 00615257953 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VANGARD LABS, INC. 00615257963 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VANGARD LABS, INC. 00615257965 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL VANGARD LABS, INC. 00615259413 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL VANGARD LABS, INC. 00615259429 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL VANGARD LABS, INC. 00615259443 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL VANGARD LABS, INC. 00615259453 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL VANGARD LABS, INC. 00615259463 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL VANGARD LABS, INC. 00615259465 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL VANGARD LABS, INC. 00615259513 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL VANGARD LABS, INC. 00615259529 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL VANGARD LABS, INC. 00615259543 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL VANGARD LABS, INC. 00615259553 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL VANGARD LABS, INC. 00615259563 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL VANGARD LABS, INC. 00615259613 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL VANGARD LABS, INC. 00615259629 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL VANGARD LABS, INC. 00615259643 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL VANGARD LABS, INC. 00615259653 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL VANGARD LABS, INC. 00615259663 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL VANGARD LABS, INC. 00615259665 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL VANGARD LABS, INC. 00615259713 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL VANGARD LABS, INC. 00615259729 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL VANGARD LABS, INC. 00615259743 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL VANGARD LABS, INC. 00615259753 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL VANGARD LABS, INC. 00615259763 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL VANGARD LABS, INC. 00615259765 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL VANGARD LABS, INC. 00615350913 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL VANGARD LABS, INC. 00615350953 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL VANGARD LABS, INC. 00615350963 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL VANGARD LABS, INC. 00615350965 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL VANGARD LABS, INC. 00615351013 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL VANGARD LABS, INC. 00615351053 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL VANGARD LABS, INC. 00615351063 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL VANGARD LABS, INC. 00615351065 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL VANGARD LABS, INC. 00615352613 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL VANGARD LABS, INC. 00615357313 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL VANGARD LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 89 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00615357413 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL VANGARD LABS, INC. 00615357429 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL VANGARD LABS, INC. 00615357443 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL VANGARD LABS, INC. 00615357453 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL VANGARD LABS, INC. 00615357463 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL VANGARD LABS, INC. 00615357465 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL VANGARD LABS, INC. 00615357488 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL VANGARD LABS, INC. 00615358429 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VANGARD LABS, INC. 00615358443 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VANGARD LABS, INC. 00615358453 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VANGARD LABS, INC. 00615358463 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VANGARD LABS, INC. 00615358465 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VANGARD LABS, INC. 00615358488 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE VANGARD LABS, INC. 00615358529 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VANGARD LABS, INC. 00615358543 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VANGARD LABS, INC. 00615358553 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VANGARD LABS, INC. 00615358563 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VANGARD LABS, INC. 00615358565 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VANGARD LABS, INC. 00615358588 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE VANGARD LABS, INC. 00615359829 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615359843 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615359853 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615359863 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615359865 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615359888 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL VANGARD LABS, INC. 00615451129 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VANGARD LABS, INC. 00615451143 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VANGARD LABS, INC. 00615451153 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VANGARD LABS, INC. 00615451163 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VANGARD LABS, INC. 00615451165 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VANGARD LABS, INC. 00615451188 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE VANGARD LABS, INC. 00615451229 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE VANGARD LABS, INC. 00615451243 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE VANGARD LABS, INC. 00615451253 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE VANGARD LABS, INC. 00615451263 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE VANGARD LABS, INC. 00615451265 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE VANGARD LABS, INC. 00615451288 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE VANGARD LABS, INC. 00615452253 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL VANGARD LABS, INC. 00615452263 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL VANGARD LABS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 90 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00615452265 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL VANGARD LABS, INC. 00615457553 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL VANGARD LABS, INC. 00615457563 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL VANGARD LABS, INC. 00615459553 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL VANGARD LABS, INC. 00615459563 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL VANGARD LABS, INC. 00615459653 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL VANGARD LABS, INC. 00615459663 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL VANGARD LABS, INC. 00615550253 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL VANGARD LABS, INC. 00615550263 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL VANGARD LABS, INC. 00641036925 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641037125 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641139731 CHLORPROMAZINE 25 MG/ML AMP 3788 CHLORPROMAZINE HCL BAXTER HEALTHCARE CORPORATION 00641139735 CHLORPROMAZINE 25 MG/ML AMP 3788 CHLORPROMAZINE HCL BAXTER HEALTHCARE CORPORATION 00641139831 CHLORPROMAZINE 25 MG/ML AMP 3788 CHLORPROMAZINE HCL BAXTER HEALTHCARE CORPORATION 00641139835 CHLORPROMAZINE 25 MG/ML AMP 3788 CHLORPROMAZINE HCL BAXTER HEALTHCARE CORPORATION 00641140833 DIAZEPAM 5 MG/ML AMPUL 3761 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641140835 DIAZEPAM 5MG/ML AMPUL 3761 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641228941 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641228943 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641320003 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641320103 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641400086 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641400088 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641400186 LORAZEPAM 1MG TABLET 3758 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641400188 LORAZEPAM 1MG TABLET 3758 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641400189 LORAZEPAM 1MG TABLET 3758 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641400286 LORAZEPAM 2MG TABLET 3759 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641400288 LORAZEPAM 2MG TABLET 3759 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641400289 LORAZEPAM 2MG TABLET 3759 LORAZEPAM BAXTER HEALTHCARE CORPORATION 00641401386 DIAZEPAM 2MG TABLET 3767 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401388 DIAZEPAM 2MG TABLET 3767 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401389 DIAZEPAM 2MG TABLET 3767 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401486 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401488 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401489 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401586 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401588 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401589 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641401686 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL BAXTER HEALTHCARE CORPORATION

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 91 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00641401688 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL BAXTER HEALTHCARE CORPORATION 00641401689 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL BAXTER HEALTHCARE CORPORATION 00641401786 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL BAXTER HEALTHCARE CORPORATION 00641401788 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL BAXTER HEALTHCARE CORPORATION 00641402586 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM BAXTER HEALTHCARE CORPORATION 00641402588 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM BAXTER HEALTHCARE CORPORATION 00641402686 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM BAXTER HEALTHCARE CORPORATION 00641402688 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM BAXTER HEALTHCARE CORPORATION 00641402786 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM BAXTER HEALTHCARE CORPORATION 00641450886 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM BAXTER HEALTHCARE CORPORATION 00641450888 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM BAXTER HEALTHCARE CORPORATION 00641450986 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM BAXTER HEALTHCARE CORPORATION 00641450988 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM BAXTER HEALTHCARE CORPORATION 00641451086 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM BAXTER HEALTHCARE CORPORATION 00641451088 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM BAXTER HEALTHCARE CORPORATION 00641451386 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL BAXTER HEALTHCARE CORPORATION 00641451486 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL BAXTER HEALTHCARE CORPORATION 00641628711 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00641628811 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM BAXTER HEALTHCARE CORPORATION 00662510047 SINEQUAN 10MG/ML ORAL CONC 46092 DOXEPIN HCL PFIZER-ROERIG 00662534066 SINEQUAN 10MG CAPSULE 46086 DOXEPIN HCL PFIZER-ROERIG 00662534082 SINEQUAN 10MG CAPSULE 46086 DOXEPIN HCL PFIZER-ROERIG 00662535066 SINEQUAN 25MG CAPSULE 46089 DOXEPIN HCL PFIZER-ROERIG 00662535082 SINEQUAN 25MG CAPSULE 46089 DOXEPIN HCL PFIZER-ROERIG 00662535094 SINEQUAN 25MG CAPSULE 46089 DOXEPIN HCL PFIZER-ROERIG 00662536066 SINEQUAN 50MG CAPSULE 46090 DOXEPIN HCL PFIZER-ROERIG 00662536082 SINEQUAN 50MG CAPSULE 46090 DOXEPIN HCL PFIZER-ROERIG 00662536094 SINEQUAN 50MG CAPSULE 46090 DOXEPIN HCL PFIZER-ROERIG 00662537050 SINEQUAN 150MG CAPSULE 46088 DOXEPIN HCL PFIZER-ROERIG 00662537073 SINEQUAN 150MG CAPSULE 46088 DOXEPIN HCL PFIZER-ROERIG 00662538066 SINEQUAN 100MG CAPSULE 46087 DOXEPIN HCL PFIZER-ROERIG 00662538082 SINEQUAN 100MG CAPSULE 46087 DOXEPIN HCL PFIZER-ROERIG 00662539066 SINEQUAN 75MG CAPSULE 46091 DOXEPIN HCL PFIZER-ROERIG 00662539082 SINEQUAN 75MG CAPSULE 46091 DOXEPIN HCL PFIZER-ROERIG 00665412006 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID INTERNATIONAL LABORATORIES 00665416006 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE INTERNATIONAL LABORATORIES 00665416009 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE INTERNATIONAL LABORATORIES 00677023201 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE UNITED RESEARCH LABORATORIES 00677023210 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE UNITED RESEARCH LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 92 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00677023301 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE UNITED RESEARCH LABORATORIES 00677023310 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE UNITED RESEARCH LABORATORIES 00677042101 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042106 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042107 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042110 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042201 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042206 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042207 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042210 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042301 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042306 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042307 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677042310 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677045401 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL UNITED RESEARCH LABORATORIES 00677045410 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL UNITED RESEARCH LABORATORIES 00677045501 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL UNITED RESEARCH LABORATORIES 00677045510 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL UNITED RESEARCH LABORATORIES 00677045601 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL UNITED RESEARCH LABORATORIES 00677045701 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL UNITED RESEARCH LABORATORIES 00677045705 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL UNITED RESEARCH LABORATORIES 00677045805 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL UNITED RESEARCH LABORATORIES 00677045810 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL UNITED RESEARCH LABORATORIES 00677045901 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL UNITED RESEARCH LABORATORIES 00677045905 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL UNITED RESEARCH LABORATORIES 00677047501 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677047510 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677047601 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677047610 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677047701 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677047710 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677047801 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677050201 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL UNITED RESEARCH LABORATORIES 00677056801 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677064501 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677078701 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL UNITED RESEARCH LABORATORIES 00677082301 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677082306 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677082310 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 93 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00677082401 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677082406 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677082410 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677082501 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677082506 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677082510 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677083201 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677083206 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL UNITED RESEARCH LABORATORIES 00677104801 DIAZEPAM 2MG TABLET 3767 DIAZEPAM UNITED RESEARCH LABORATORIES 00677104805 DIAZEPAM 2MG TABLET 3767 DIAZEPAM UNITED RESEARCH LABORATORIES 00677105001 DIAZEPAM 10MG TABLET 3766 DIAZEPAM UNITED RESEARCH LABORATORIES 00677105005 DIAZEPAM 10MG TABLET 3766 DIAZEPAM UNITED RESEARCH LABORATORIES 00677105601 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105605 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105606 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105607 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105701 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105705 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105706 LORAZEPAM 1MG TABLET 3758 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105707 LORAZEPAM 1MG TABLET 3758 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105710 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105801 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105805 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105806 LORAZEPAM 2MG TABLET 3759 LORAZEPAM UNITED RESEARCH LABORATORIES 00677105807 LORAZEPAM 2MG TABLET 3759 LORAZEPAM UNITED RESEARCH LABORATORIES 00677107901 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID UNITED RESEARCH LABORATORIES 00677108821 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM UNITED RESEARCH LABORATORIES 00677109201 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE UNITED RESEARCH LABORATORIES 00677109210 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE UNITED RESEARCH LABORATORIES 00677110101 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL UNITED RESEARCH LABORATORIES 00677110201 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL UNITED RESEARCH LABORATORIES 00677110301 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL UNITED RESEARCH LABORATORIES 00677110401 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL UNITED RESEARCH LABORATORIES 00677110501 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL UNITED RESEARCH LABORATORIES 00677111501 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL UNITED RESEARCH LABORATORIES 00677111601 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL UNITED RESEARCH LABORATORIES 00677111701 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL UNITED RESEARCH LABORATORIES 00677111801 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL UNITED RESEARCH LABORATORIES 00677112001 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLUNITED RESEARCH LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 94 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00677112101 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLUNITED RESEARCH LABORATORIES 00677112201 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLUNITED RESEARCH LABORATORIES 00677112301 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLUNITED RESEARCH LABORATORIES 00677113301 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL UNITED RESEARCH LABORATORIES 00677113305 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL UNITED RESEARCH LABORATORIES 00677113401 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL UNITED RESEARCH LABORATORIES 00677113405 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL UNITED RESEARCH LABORATORIES 00677114301 AMITRIP/CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEUNITED RESEARCH LABORATORIES 00677115201 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE UNITED RESEARCH LABORATORIES 00677115533 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM UNITED RESEARCH LABORATORIES 00677117501 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM UNITED RESEARCH LABORATORIES 00677117601 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM UNITED RESEARCH LABORATORIES 00677117701 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM UNITED RESEARCH LABORATORIES 00677118101 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM UNITED RESEARCH LABORATORIES 00677118201 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM UNITED RESEARCH LABORATORIES 00677118301 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM UNITED RESEARCH LABORATORIES 00677119801 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677119901 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677120301 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL UNITED RESEARCH LABORATORIES 00677121001 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL UNITED RESEARCH LABORATORIES 00677121401 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL UNITED RESEARCH LABORATORIES 00677121501 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL UNITED RESEARCH LABORATORIES 00677121601 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL UNITED RESEARCH LABORATORIES 00677121701 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL UNITED RESEARCH LABORATORIES 00677121801 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL UNITED RESEARCH LABORATORIES 00677121901 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL UNITED RESEARCH LABORATORIES 00677122001 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL UNITED RESEARCH LABORATORIES 00677130201 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL UNITED RESEARCH LABORATORIES 00677130205 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL UNITED RESEARCH LABORATORIES 00677130207 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL UNITED RESEARCH LABORATORIES 00677137801 AMOXAPINE 50MG TABLET 46084 AMOXAPINE UNITED RESEARCH LABORATORIES 00677137901 AMOXAPINE 100MG TABLET 46081 AMOXAPINE UNITED RESEARCH LABORATORIES 00677138007 AMOXAPINE 150MG TABLET 46082 AMOXAPINE UNITED RESEARCH LABORATORIES 00677138501 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE UNITED RESEARCH LABORATORIES 00677138601 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE UNITED RESEARCH LABORATORIES 00677138801 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE UNITED RESEARCH LABORATORIES 00677138901 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE UNITED RESEARCH LABORATORIES 00677143201 AMOXAPINE 25MG TABLET 46083 AMOXAPINE UNITED RESEARCH LABORATORIES 00677149601 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM UNITED RESEARCH LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 95 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00677149605 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM UNITED RESEARCH LABORATORIES 00677149701 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM UNITED RESEARCH LABORATORIES 00677149705 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM UNITED RESEARCH LABORATORIES 00677149801 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM UNITED RESEARCH LABORATORIES 00677149805 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM UNITED RESEARCH LABORATORIES 00677155501 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677155601 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677155701 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677155801 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL UNITED RESEARCH LABORATORIES 00677176601 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL UNITED RESEARCH LABORATORIES 00677176605 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL UNITED RESEARCH LABORATORIES 00677176610 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL UNITED RESEARCH LABORATORIES 00677176701 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL UNITED RESEARCH LABORATORIES 00677176705 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL UNITED RESEARCH LABORATORIES 00677176710 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL UNITED RESEARCH LABORATORIES 00686222613 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 00686223113 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 00686223313 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 00686248025 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL LABELER NOT ON FILE 00686248725 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL LABELER NOT ON FILE 00686249725 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL LABELER NOT ON FILE 00703500301 FLUPHENAZINE DEC 25 MG/ML VL 3818 FLUPHENAZINE DECANOATE TEVA PARENTERAL MEDICINES INC 00703701101 HALOPERIDOL DEC 50MG/ML VL 3967 HALOPERIDOL DECANOATE TEVA PARENTERAL MEDICINES INC 00703701103 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE TEVA PARENTERAL MEDICINES INC 00703701301 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE TEVA PARENTERAL MEDICINES INC 00703702101 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE TEVA PARENTERAL MEDICINES INC 00703702103 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE TEVA PARENTERAL MEDICINES INC 00703702301 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE TEVA PARENTERAL MEDICINES INC 00703704101 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE TEVA PARENTERAL MEDICINES INC 00703704103 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE TEVA PARENTERAL MEDICINES INC 00703704104 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE TEVA PARENTERAL MEDICINES INC 00703704501 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE TEVA PARENTERAL MEDICINES INC 00722540401 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE LABELER NOT ON FILE 00722540403 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE LABELER NOT ON FILE 00722543501 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE LABELER NOT ON FILE 00722543503 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE LABELER NOT ON FILE 00777310401 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310402 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310407 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 96 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00777310481 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310482 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310501 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310502 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310507 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310530 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310533 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310581 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310582 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777310730 PROZAC 40 MG PULVULE 46215 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00777512058 PROZAC 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL DISTA PRODUCTS CO DIV OF ELI LILLY & CO 00781103001 TRIFLUOPERAZINE 1 MG TABLET 3851 TRIFLUOPERAZINE HCL SANDOZ 00781103013 TRIFLUOPERAZINE 1 MG TABLET 3851 TRIFLUOPERAZINE HCL SANDOZ 00781103201 TRIFLUOPERAZINE 2 MG TABLET 3853 TRIFLUOPERAZINE HCL SANDOZ 00781103210 TRIFLUOPERAZINE 2 MG TABLET 3853 TRIFLUOPERAZINE HCL SANDOZ 00781103213 TRIFLUOPERAZINE 2 MG TABLET 3853 TRIFLUOPERAZINE HCL SANDOZ 00781103401 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL SANDOZ 00781103410 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL SANDOZ 00781103413 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL SANDOZ 00781103601 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL SANDOZ 00781103610 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL SANDOZ 00781103613 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL SANDOZ 00781104601 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE SANDOZ 00781104610 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE SANDOZ 00781104613 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE SANDOZ 00781104701 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE SANDOZ 00781104710 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE SANDOZ 00781104713 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE SANDOZ 00781104801 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE SANDOZ 00781104810 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE SANDOZ 00781104813 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE SANDOZ 00781104901 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE SANDOZ 00781104913 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE SANDOZ 00781105301 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SANDOZ 00781105310 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SANDOZ 00781106101 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SANDOZ 00781106105 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SANDOZ 00781106110 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SANDOZ 00781106113 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM SANDOZ

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 97 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00781106401 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SANDOZ 00781106410 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SANDOZ 00781107701 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SANDOZ 00781107705 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SANDOZ 00781107710 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SANDOZ 00781107713 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM SANDOZ 00781107901 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SANDOZ 00781107905 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SANDOZ 00781107910 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SANDOZ 00781107913 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM SANDOZ 00781108901 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SANDOZ 00781108905 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SANDOZ 00781121701 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM SANDOZ 00781121801 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM SANDOZ 00781121805 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM SANDOZ 00781121901 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM SANDOZ 00781121905 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM SANDOZ 00781126501 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781126505 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781126513 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781126601 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781126701 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781126705 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781126713 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781126801 AMITRIP/PERPHEN 50-4 TABLET 46188 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781127301 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781127305 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781127313 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLSANDOZ 00781132601 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM SANDOZ 00781132605 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM SANDOZ 00781132610 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM SANDOZ 00781132613 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM SANDOZ 00781132701 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM SANDOZ 00781132705 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM SANDOZ 00781132710 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM SANDOZ 00781132713 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM SANDOZ 00781132801 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM SANDOZ 00781132805 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM SANDOZ 00781132810 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM SANDOZ

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 98 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00781132813 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM SANDOZ 00781132901 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM SANDOZ 00781132905 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM SANDOZ 00781139101 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL SANDOZ 00781139110 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL SANDOZ 00781139113 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL SANDOZ 00781139201 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL SANDOZ 00781139210 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL SANDOZ 00781139213 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL SANDOZ 00781139301 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL SANDOZ 00781139310 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL SANDOZ 00781139313 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL SANDOZ 00781139601 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL SANDOZ 00781139610 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL SANDOZ 00781139613 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL SANDOZ 00781139701 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL SANDOZ 00781139710 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL SANDOZ 00781139713 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL SANDOZ 00781139801 HALOPERIDOL 20 MG TABLET 3976 HALOPERIDOL SANDOZ 00781140301 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM SANDOZ 00781140305 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM SANDOZ 00781140313 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM SANDOZ 00781140401 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SANDOZ 00781140405 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SANDOZ 00781140410 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SANDOZ 00781140413 LORAZEPAM 1MG TABLET 3758 LORAZEPAM SANDOZ 00781140501 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SANDOZ 00781140505 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SANDOZ 00781140513 LORAZEPAM 2MG TABLET 3759 LORAZEPAM SANDOZ 00781141001 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE SANDOZ 00781141010 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE SANDOZ 00781143601 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL SANDOZ 00781143605 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL SANDOZ 00781143613 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL SANDOZ 00781143650 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL SANDOZ 00781143701 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL SANDOZ 00781143705 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL SANDOZ 00781143713 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL SANDOZ 00781143750 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL SANDOZ

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 99 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00781143801 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL SANDOZ 00781143805 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL SANDOZ 00781143813 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL SANDOZ 00781143850 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL SANDOZ 00781143901 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL SANDOZ 00781143905 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL SANDOZ 00781143913 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL SANDOZ 00781143950 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL SANDOZ 00781148201 DIAZEPAM 2MG TABLET 3767 DIAZEPAM SANDOZ 00781148205 DIAZEPAM 2MG TABLET 3767 DIAZEPAM SANDOZ 00781148213 DIAZEPAM 2MG TABLET 3767 DIAZEPAM SANDOZ 00781148301 DIAZEPAM 5MG TABLET 3768 DIAZEPAM SANDOZ 00781148305 DIAZEPAM 5MG TABLET 3768 DIAZEPAM SANDOZ 00781148313 DIAZEPAM 5MG TABLET 3768 DIAZEPAM SANDOZ 00781148401 DIAZEPAM 10MG TABLET 3766 DIAZEPAM SANDOZ 00781148405 DIAZEPAM 10MG TABLET 3766 DIAZEPAM SANDOZ 00781148413 DIAZEPAM 10MG TABLET 3766 DIAZEPAM SANDOZ 00781148601 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SANDOZ 00781148610 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SANDOZ 00781148613 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL SANDOZ 00781148701 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SANDOZ 00781148710 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SANDOZ 00781148713 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL SANDOZ 00781148801 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SANDOZ 00781148810 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SANDOZ 00781148813 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL SANDOZ 00781148901 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL SANDOZ 00781148913 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL SANDOZ 00781149001 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SANDOZ 00781149013 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL SANDOZ 00781149101 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL SANDOZ 00781149113 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL SANDOZ 00781160401 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL SANDOZ 00781160410 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL SANDOZ 00781160413 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL SANDOZ 00781161401 THIORIDAZINE 15 MG TABLET 3861 THIORIDAZINE HCL SANDOZ 00781161413 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL SANDOZ 00781162401 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL SANDOZ 00781162410 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL SANDOZ

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 100 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00781162413 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL SANDOZ 00781163101 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL SANDOZ 00781163201 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL SANDOZ 00781163301 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL SANDOZ 00781163401 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL SANDOZ 00781163410 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL SANDOZ 00781163413 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL SANDOZ 00781164401 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL SANDOZ 00781164410 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL SANDOZ 00781164413 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL SANDOZ 00781166401 THIORIDAZINE 150 MG TABLET 3862 THIORIDAZINE HCL SANDOZ 00781167401 THIORIDAZINE 200 MG TABLET 3863 THIORIDAZINE HCL SANDOZ 00781171501 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL SANDOZ 00781171513 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL SANDOZ 00781171601 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL SANDOZ 00781171610 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL SANDOZ 00781171613 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL SANDOZ 00781171701 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL SANDOZ 00781171710 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL SANDOZ 00781171713 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL SANDOZ 00781171801 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL SANDOZ 00781171810 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL SANDOZ 00781171813 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL SANDOZ 00781171901 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL SANDOZ 00781171910 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL SANDOZ 00781171913 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL SANDOZ 00781176201 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL SANDOZ 00781176401 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL SANDOZ 00781176410 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL SANDOZ 00781176413 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL SANDOZ 00781176601 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SANDOZ 00781176610 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SANDOZ 00781176613 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SANDOZ 00781180701 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL SANDOZ 00781180705 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL SANDOZ 00781180710 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL SANDOZ 00781180713 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL SANDOZ 00781180801 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL SANDOZ 00781180813 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL SANDOZ

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 101 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00781182601 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL SANDOZ 00781184401 AMOXAPINE 25MG TABLET 46083 AMOXAPINE SANDOZ 00781184501 AMOXAPINE 50MG TABLET 46084 AMOXAPINE SANDOZ 00781184601 AMOXAPINE 100MG TABLET 46081 AMOXAPINE SANDOZ 00781184731 AMOXAPINE 150MG TABLET 46082 AMOXAPINE SANDOZ 00781186501 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM SANDOZ 00781186505 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM SANDOZ 00781186601 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM SANDOZ 00781186605 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM SANDOZ 00781186701 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM SANDOZ 00781196731 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL SANDOZ 00781196931 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL SANDOZ 00781197101 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL SANDOZ 00781197201 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SANDOZ 00781197210 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SANDOZ 00781197213 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL SANDOZ 00781197301 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL SANDOZ 00781197310 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL SANDOZ 00781197313 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL SANDOZ 00781197401 DESIPRAMINE 75 MG TABLET 46108 DESIPRAMINE HCL SANDOZ 00781197501 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL SANDOZ 00781197650 DESIPRAMINE 150 MG TABLET 46105 DESIPRAMINE HCL SANDOZ 00781199101 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL SANDOZ 00781199231 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL SANDOZ 00781202701 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL SANDOZ 00781203701 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL SANDOZ 00781204701 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL SANDOZ 00781208001 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL SANDOZ 00781208005 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL SANDOZ 00781208010 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL SANDOZ 00781208201 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL SANDOZ 00781208205 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL SANDOZ 00781208210 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL SANDOZ 00781208401 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL SANDOZ 00781208405 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL SANDOZ 00781208410 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL SANDOZ 00781210001 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE SANDOZ 00781210010 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE SANDOZ 00781220301 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID SANDOZ

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 102 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00781222601 THIOTHIXENE 1 MG CAPSULE 3995 THIOTHIXENE SANDOZ 00781222613 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE SANDOZ 00781222701 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE SANDOZ 00781222710 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE SANDOZ 00781222713 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE SANDOZ 00781222801 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE SANDOZ 00781222810 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE SANDOZ 00781222813 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE SANDOZ 00781222901 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE SANDOZ 00781222910 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE SANDOZ 00781222913 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE SANDOZ 00781263001 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL SANDOZ 00781263013 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL SANDOZ 00781263101 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL SANDOZ 00781263105 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL SANDOZ 00781263113 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL SANDOZ 00781263201 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL SANDOZ 00781263213 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL SANDOZ 00781263301 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL SANDOZ 00781271001 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE SANDOZ 00781271101 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE SANDOZ 00781271201 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE SANDOZ 00781271301 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE SANDOZ 00781280001 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL SANDOZ 00781280013 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL SANDOZ 00781280113 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL SANDOZ 00781280201 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL SANDOZ 00781280210 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL SANDOZ 00781280301 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL SANDOZ 00781280401 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL SANDOZ 00781280413 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL SANDOZ 00781280901 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM SANDOZ 00781281001 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM SANDOZ 00781281005 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM SANDOZ 00781281101 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM SANDOZ 00781282201 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SANDOZ 00781282210 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SANDOZ 00781282301 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SANDOZ 00781282310 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SANDOZ

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 103 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00781282401 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SANDOZ 00781282410 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SANDOZ 00781282431 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SANDOZ 00781282708 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SANDOZ 00781282808 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SANDOZ 00781315972 OLANZAPINE 10 MG VIAL 50386 OLANZAPINE SANDOZ 00781400704 CHLORPROMAZINE 30MG/ML CONC 3795 CHLORPROMAZINE HCL SANDOZ 00781400908 CHLORPROMAZINE 100MG/ML CON 3794 CHLORPROMAZINE HCL SANDOZ 00781401704 CHLORPROMAZINE 10MG/5ML SYR 3793 CHLORPROMAZINE HCL SANDOZ 00781404502 TRIFLUOPERAZINE 10MG/ML CON 3850 TRIFLUOPERAZINE HCL SANDOZ 00781504001 FLUVOXAMINE MALEATE 25 MG TB 46208 FLUVOXAMINE MALEATE SANDOZ 00781504010 FLUVOXAMINE MALEATE 25MG TB 46208 FLUVOXAMINE MALEATE SANDOZ 00781504101 FLUVOXAMINE MALEATE 50 MG TB 46209 FLUVOXAMINE MALEATE SANDOZ 00781504110 FLUVOXAMINE MALEATE 50MG TB 46209 FLUVOXAMINE MALEATE SANDOZ 00781504201 FLUVOXAMINE MAL 100 MG TAB 46210 FLUVOXAMINE MALEATE SANDOZ 00781504210 FLUVOXAMINE MAL 100MG TAB 46210 FLUVOXAMINE MALEATE SANDOZ 00781515701 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SANDOZ 00781515801 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SANDOZ 00781515901 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SANDOZ 00781531008 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE SANDOZ 00781531108 RISPERIDONE 1 MG ODT 51799 RISPERIDONE SANDOZ 00781531208 RISPERIDONE 2 MG ODT 51800 RISPERIDONE SANDOZ 00781531308 RISPERIDONE 3 MG ODT 59402 RISPERIDONE SANDOZ 00781531408 RISPERIDONE 4 MG ODT 59403 RISPERIDONE SANDOZ 00781591401 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL SANDOZ 00781591501 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL SANDOZ 00781610016 LITHIUM CIT 8MEQ/5ML SYRUP 4006 LITHIUM CITRATE SANDOZ 00781615004 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL SANDOZ 00781620504 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE SANDOZ 00781670116 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM SANDOZ 00814230014 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 00814230114 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL LABELER NOT ON FILE 00814239514 DIAZEPAM 2MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00814239528 DIAZEPAM 2MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 00814239614 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00814239628 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 00814239714 DIAZEPAM 10MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00814239728 DIAZEPAM 10MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 00814239940 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 104 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00814471814 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE LABELER NOT ON FILE 00814595614 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 00814798014 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 00814798214 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 00832030000 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030010 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030100 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030110 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030200 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030210 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030300 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030310 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030400 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030410 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL UPSHER-SMITH LABORATORIES, INC. 00832030700 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL UPSHER-SMITH LABORATORIES, INC. 00832030710 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL UPSHER-SMITH LABORATORIES, INC. 00832030750 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL UPSHER-SMITH LABORATORIES, INC. 00832100700 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID UPSHER-SMITH LABORATORIES, INC. 00832100800 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID UPSHER-SMITH LABORATORIES, INC. 00839113006 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL MOORE MEDICAL CORP. 00839113016 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL MOORE MEDICAL CORP. 00839113106 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL MOORE MEDICAL CORP. 00839113116 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL MOORE MEDICAL CORP. 00839113206 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL MOORE MEDICAL CORP. 00839113212 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL MOORE MEDICAL CORP. 00839113216 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL MOORE MEDICAL CORP. 00839114606 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL MOORE MEDICAL CORP. 00839114806 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL MOORE MEDICAL CORP. 00839115106 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL MOORE MEDICAL CORP. 00839115506 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL MOORE MEDICAL CORP. 00839115806 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL MOORE MEDICAL CORP. 00839137006 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL MOORE MEDICAL CORP. 00839137106 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MOORE MEDICAL CORP. 00839137116 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MOORE MEDICAL CORP. 00839137206 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MOORE MEDICAL CORP. 00839137216 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MOORE MEDICAL CORP. 00839500406 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE MOORE MEDICAL CORP. 00839500416 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE MOORE MEDICAL CORP. 00839507006 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE MOORE MEDICAL CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 105 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00839556230 CHLORPROMAZINE 25MG/ML VIAL 3790 CHLORPROMAZINE HCL MOORE MEDICAL CORP. 00839619106 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839619116 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839619206 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839619216 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839619306 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839619316 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839619406 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839619416 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839621706 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839621712 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839622306 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839622506 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839622512 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839622606 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839622706 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839622712 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839640106 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL MOORE MEDICAL CORP. 00839644006 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL MOORE MEDICAL CORP. 00839644106 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL MOORE MEDICAL CORP. 00839644206 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL MOORE MEDICAL CORP. 00839644212 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL MOORE MEDICAL CORP. 00839670306 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839670316 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839670406 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839670416 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839670506 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839670516 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839672006 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839705665 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL MOORE MEDICAL CORP. 00839713106 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MOORE MEDICAL CORP. 00839713116 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MOORE MEDICAL CORP. 00839713206 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MOORE MEDICAL CORP. 00839713216 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MOORE MEDICAL CORP. 00839713306 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MOORE MEDICAL CORP. 00839713312 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MOORE MEDICAL CORP. 00839713316 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MOORE MEDICAL CORP. 00839714606 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MOORE MEDICAL CORP. 00839714616 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MOORE MEDICAL CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 106 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00839714706 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MOORE MEDICAL CORP. 00839714712 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MOORE MEDICAL CORP. 00839714906 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE MOORE MEDICAL CORP. 00839714916 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE MOORE MEDICAL CORP. 00839718006 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MOORE MEDICAL CORP. 00839719030 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM MOORE MEDICAL CORP. 00839719569 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM MOORE MEDICAL CORP. 00839722006 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL MOORE MEDICAL CORP. 00839722106 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MOORE MEDICAL CORP. 00839722116 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MOORE MEDICAL CORP. 00839722206 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MOORE MEDICAL CORP. 00839722216 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MOORE MEDICAL CORP. 00839722406 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL MOORE MEDICAL CORP. 00839723306 AMITRIP/PERPHEN 50-4 TABLET 46188 PERPHENAZINE/AMITRIPTYLINE HCLMOORE MEDICAL CORP. 00839725106 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MOORE MEDICAL CORP. 00839725116 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MOORE MEDICAL CORP. 00839725206 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MOORE MEDICAL CORP. 00839725212 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MOORE MEDICAL CORP. 00839727912 AMITRIP/CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEMOORE MEDICAL CORP. 00839728006 AMITRIP/CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEMOORE MEDICAL CORP. 00839728012 AMITRIP/CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEMOORE MEDICAL CORP. 00839728906 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE MOORE MEDICAL CORP. 00839729106 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE MOORE MEDICAL CORP. 00839733506 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MOORE MEDICAL CORP. 00839733512 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MOORE MEDICAL CORP. 00839733606 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MOORE MEDICAL CORP. 00839733612 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MOORE MEDICAL CORP. 00839733706 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM MOORE MEDICAL CORP. 00839734606 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MOORE MEDICAL CORP. 00839734616 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MOORE MEDICAL CORP. 00839734706 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MOORE MEDICAL CORP. 00839734716 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MOORE MEDICAL CORP. 00839734806 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MOORE MEDICAL CORP. 00839734816 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MOORE MEDICAL CORP. 00839734906 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MOORE MEDICAL CORP. 00839734916 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MOORE MEDICAL CORP. 00839739806 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL MOORE MEDICAL CORP. 00839739812 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL MOORE MEDICAL CORP. 00839741206 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL MOORE MEDICAL CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 107 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00839742306 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MOORE MEDICAL CORP. 00839742312 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MOORE MEDICAL CORP. 00839742406 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MOORE MEDICAL CORP. 00839742412 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MOORE MEDICAL CORP. 00839742506 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MOORE MEDICAL CORP. 00839742512 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MOORE MEDICAL CORP. 00839742606 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE MOORE MEDICAL CORP. 00839744806 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL MOORE MEDICAL CORP. 00839744906 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL MOORE MEDICAL CORP. 00839745006 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL MOORE MEDICAL CORP. 00839745206 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL MOORE MEDICAL CORP. 00839747065 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL MOORE MEDICAL CORP. 00839749506 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE MOORE MEDICAL CORP. 00839749606 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE MOORE MEDICAL CORP. 00839749706 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE MOORE MEDICAL CORP. 00839749806 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE MOORE MEDICAL CORP. 00839750106 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM MOORE MEDICAL CORP. 00839750112 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM MOORE MEDICAL CORP. 00839750206 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM MOORE MEDICAL CORP. 00839750212 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM MOORE MEDICAL CORP. 00839750306 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM MOORE MEDICAL CORP. 00839750706 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL MOORE MEDICAL CORP. 00839750712 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL MOORE MEDICAL CORP. 00839750906 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL MOORE MEDICAL CORP. 00839755106 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MOORE MEDICAL CORP. 00839755116 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MOORE MEDICAL CORP. 00839755206 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MOORE MEDICAL CORP. 00839755216 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MOORE MEDICAL CORP. 00839755306 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL MOORE MEDICAL CORP. 00839760406 AMOXAPINE 25MG TABLET 46083 AMOXAPINE MOORE MEDICAL CORP. 00839760506 AMOXAPINE 50MG TABLET 46084 AMOXAPINE MOORE MEDICAL CORP. 00839760606 AMOXAPINE 100MG TABLET 46081 AMOXAPINE MOORE MEDICAL CORP. 00839760719 AMOXAPINE 150MG TABLET 46082 AMOXAPINE MOORE MEDICAL CORP. 00839784006 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MOORE MEDICAL CORP. 00839785106 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM MOORE MEDICAL CORP. 00839785112 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM MOORE MEDICAL CORP. 00839785206 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM MOORE MEDICAL CORP. 00839785212 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM MOORE MEDICAL CORP. 00839785306 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM MOORE MEDICAL CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 108 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00839785312 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM MOORE MEDICAL CORP. 00839789206 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL MOORE MEDICAL CORP. 00839789216 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL MOORE MEDICAL CORP. 00839789306 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MOORE MEDICAL CORP. 00839789316 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MOORE MEDICAL CORP. 00839789406 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MOORE MEDICAL CORP. 00839789416 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MOORE MEDICAL CORP. 00839789506 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL MOORE MEDICAL CORP. 00839789516 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL MOORE MEDICAL CORP. 00839789606 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL MOORE MEDICAL CORP. 00839789616 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL MOORE MEDICAL CORP. 00839790206 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM MOORE MEDICAL CORP. 00839790216 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM MOORE MEDICAL CORP. 00839790306 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MOORE MEDICAL CORP. 00839790316 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MOORE MEDICAL CORP. 00839790406 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MOORE MEDICAL CORP. 00839790416 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MOORE MEDICAL CORP. 00853160870 THORAMED 25MG/ML VIAL 3790 CHLORPROMAZINE HCL MAYS LABORATORIES INC 00879004401 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE HALSEY DRUG COMPANY, INC. 00879004410 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE HALSEY DRUG COMPANY, INC. 00879049105 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL HALSEY DRUG COMPANY, INC. 00879049205 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HALSEY DRUG COMPANY, INC. 00904004460 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE MAJOR PHARMACEUTICALS 00904004480 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE MAJOR PHARMACEUTICALS 00904004560 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE MAJOR PHARMACEUTICALS 00904004580 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE MAJOR PHARMACEUTICALS 00904009040 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL MAJOR PHARMACEUTICALS 00904009060 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL MAJOR PHARMACEUTICALS 00904009160 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL MAJOR PHARMACEUTICALS 00904009180 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL MAJOR PHARMACEUTICALS 00904009240 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL MAJOR PHARMACEUTICALS 00904009260 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL MAJOR PHARMACEUTICALS 00904020060 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020061 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020080 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020160 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020161 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020180 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020246 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 109 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904020260 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020261 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020280 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020360 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020361 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020460 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020461 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904020560 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904056160 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL MAJOR PHARMACEUTICALS 00904092570 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL MAJOR PHARMACEUTICALS 00904092580 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL MAJOR PHARMACEUTICALS 00904092770 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MAJOR PHARMACEUTICALS 00904092780 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MAJOR PHARMACEUTICALS 00904092970 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MAJOR PHARMACEUTICALS 00904092980 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MAJOR PHARMACEUTICALS 00904126060 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126061 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126160 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126161 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126180 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126260 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126261 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126280 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126360 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126361 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126460 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126461 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904126560 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL MAJOR PHARMACEUTICALS 00904150040 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MAJOR PHARMACEUTICALS 00904150060 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MAJOR PHARMACEUTICALS 00904150061 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MAJOR PHARMACEUTICALS 00904150140 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MAJOR PHARMACEUTICALS 00904150160 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MAJOR PHARMACEUTICALS 00904150161 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MAJOR PHARMACEUTICALS 00904150180 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MAJOR PHARMACEUTICALS 00904150240 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MAJOR PHARMACEUTICALS 00904150260 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MAJOR PHARMACEUTICALS 00904150261 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MAJOR PHARMACEUTICALS 00904150280 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 110 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904157040 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904157060 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904157080 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904157140 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904157160 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904157180 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904157260 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904157360 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904158260 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904158261 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904158280 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904158360 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL MAJOR PHARMACEUTICALS 00904161460 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904161480 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904161660 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904161680 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904161760 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904161780 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904161860 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904161880 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904172920 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE MAJOR PHARMACEUTICALS 00904173440 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL MAJOR PHARMACEUTICALS 00904173460 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL MAJOR PHARMACEUTICALS 00904173461 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL MAJOR PHARMACEUTICALS 00904173560 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL MAJOR PHARMACEUTICALS 00904179361 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904179460 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904179561 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904179661 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904183040 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183060 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183061 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183160 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183161 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183180 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183260 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183261 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183280 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183340 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 111 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904183360 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MAJOR PHARMACEUTICALS 00904183361 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MAJOR PHARMACEUTICALS 00904187240 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187260 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187261 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187360 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187361 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187440 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187460 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187461 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187540 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE MAJOR PHARMACEUTICALS 00904187560 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE MAJOR PHARMACEUTICALS 00904189040 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM MAJOR PHARMACEUTICALS 00904189060 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM MAJOR PHARMACEUTICALS 00904189140 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM MAJOR PHARMACEUTICALS 00904189160 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM MAJOR PHARMACEUTICALS 00904189240 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM MAJOR PHARMACEUTICALS 00904189260 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM MAJOR PHARMACEUTICALS 00904205260 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904205261 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904205280 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904205360 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904205361 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904205380 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904210160 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MAJOR PHARMACEUTICALS 00904210316 VALPROIC ACID 250 MG/5 MG SYR 4535 VALPROATE SODIUM MAJOR PHARMACEUTICALS 00904216160 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904216161 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904219160 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904219161 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904219180 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904219260 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904219261 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904219280 CHLORPROMAZINE 200MG TABLET 3798 CHLORPROMAZINE HCL MAJOR PHARMACEUTICALS 00904231060 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE MAJOR PHARMACEUTICALS 00904231160 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE MAJOR PHARMACEUTICALS 00904231260 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE MAJOR PHARMACEUTICALS 00904231360 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE MAJOR PHARMACEUTICALS 00904289060 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 112 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904289140 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE MAJOR PHARMACEUTICALS 00904289160 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE MAJOR PHARMACEUTICALS 00904289240 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE MAJOR PHARMACEUTICALS 00904289260 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE MAJOR PHARMACEUTICALS 00904289340 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE MAJOR PHARMACEUTICALS 00904289360 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE MAJOR PHARMACEUTICALS 00904289920 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL MAJOR PHARMACEUTICALS 00904289930 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL MAJOR PHARMACEUTICALS 00904291260 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904291280 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904291416 LITHIUM CIT 8 MEQ/5 ML SYRUP 4006 LITHIUM CITRATE MAJOR PHARMACEUTICALS 00904295561 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE MAJOR PHARMACEUTICALS 00904295640 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE MAJOR PHARMACEUTICALS 00904295661 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE MAJOR PHARMACEUTICALS 00904295761 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE MAJOR PHARMACEUTICALS 00904295861 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE MAJOR PHARMACEUTICALS 00904332360 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL MAJOR PHARMACEUTICALS 00904332361 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL MAJOR PHARMACEUTICALS 00904332460 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL MAJOR PHARMACEUTICALS 00904332560 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL MAJOR PHARMACEUTICALS 00904339270 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904367340 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367360 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367361 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367440 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367460 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367461 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367540 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367560 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367561 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367640 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367660 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904367661 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL MAJOR PHARMACEUTICALS 00904390140 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MAJOR PHARMACEUTICALS 00904390160 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MAJOR PHARMACEUTICALS 00904390161 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MAJOR PHARMACEUTICALS 00904390180 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MAJOR PHARMACEUTICALS 00904390240 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MAJOR PHARMACEUTICALS 00904390260 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 113 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904390280 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MAJOR PHARMACEUTICALS 00904390340 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MAJOR PHARMACEUTICALS 00904390360 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MAJOR PHARMACEUTICALS 00904390380 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MAJOR PHARMACEUTICALS 00904397040 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904397060 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904397140 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904397160 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904397360 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904399040 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399060 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399061 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399080 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399160 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399161 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399260 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399270 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904399460 AMOXAPINE 25MG TABLET 46083 AMOXAPINE MAJOR PHARMACEUTICALS 00904399461 AMOXAPINE 25MG TABLET 46083 AMOXAPINE MAJOR PHARMACEUTICALS 00904399560 AMOXAPINE 50MG TABLET 46084 AMOXAPINE MAJOR PHARMACEUTICALS 00904399561 AMOXAPINE 50MG TABLET 46084 AMOXAPINE MAJOR PHARMACEUTICALS 00904399660 AMOXAPINE 100MG TABLET 46081 AMOXAPINE MAJOR PHARMACEUTICALS 00904399746 AMOXAPINE 150MG TABLET 46082 AMOXAPINE MAJOR PHARMACEUTICALS 00904515960 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904516040 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904516060 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MAJOR PHARMACEUTICALS 00904521940 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904521960 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904521980 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904522040 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904522060 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MAJOR PHARMACEUTICALS 00904524060 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904524080 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904524160 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904524180 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904524260 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904524280 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904529052 ST. JOHN'S WORT 300MG CAP 46333 ST. JOHN'S WORT MAJOR PHARMACEUTICALS 00904556860 LITHIUM CARBONATE 300 MG CP 4001 LITHIUM CARBONATE MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 114 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904556880 LITHIUM CARBONATE 300 MG CP 4001 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904558740 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558760 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558761 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558840 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558860 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558861 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558960 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558961 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904558993 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904564960 LITHIUM ER 300 MG TABLET 4004 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904567661 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904567761 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904567861 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904567961 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904578461 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MAJOR PHARMACEUTICALS 00904578561 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MAJOR PHARMACEUTICALS 00904585861 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904585961 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904586061 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904586161 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904586261 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904586361 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904586461 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904586561 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904586661 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL MAJOR PHARMACEUTICALS 00904586761 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL MAJOR PHARMACEUTICALS 00904586861 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL MAJOR PHARMACEUTICALS 00904588061 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM MAJOR PHARMACEUTICALS 00904588161 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM MAJOR PHARMACEUTICALS 00904591361 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL MAJOR PHARMACEUTICALS 00904591461 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL MAJOR PHARMACEUTICALS 00904592361 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MAJOR PHARMACEUTICALS 00904592461 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MAJOR PHARMACEUTICALS 00904592561 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MAJOR PHARMACEUTICALS 00904597361 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE MAJOR PHARMACEUTICALS 00904597461 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE MAJOR PHARMACEUTICALS 00904597561 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE MAJOR PHARMACEUTICALS 00904597661 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 115 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904597761 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE MAJOR PHARMACEUTICALS 00904597861 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE MAJOR PHARMACEUTICALS 00904598061 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MAJOR PHARMACEUTICALS 00904598161 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MAJOR PHARMACEUTICALS 00904598261 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MAJOR PHARMACEUTICALS 00904599061 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM MAJOR PHARMACEUTICALS 00904600740 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MAJOR PHARMACEUTICALS 00904600760 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MAJOR PHARMACEUTICALS 00904600860 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MAJOR PHARMACEUTICALS 00904600960 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MAJOR PHARMACEUTICALS 00904606161 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL MAJOR PHARMACEUTICALS 00904607361 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM MAJOR PHARMACEUTICALS 00904608461 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE MAJOR PHARMACEUTICALS 00904608561 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE MAJOR PHARMACEUTICALS 00904608661 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE MAJOR PHARMACEUTICALS 00904608761 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL MAJOR PHARMACEUTICALS 00904608861 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL MAJOR PHARMACEUTICALS 00904608961 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL MAJOR PHARMACEUTICALS 00904609361 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL MAJOR PHARMACEUTICALS 00904610961 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904611061 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904611161 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904611261 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MAJOR PHARMACEUTICALS 00904612961 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL MAJOR PHARMACEUTICALS 00904613660 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904613661 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904613680 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904620460 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904620560 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE MAJOR PHARMACEUTICALS 00904624661 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL MAJOR PHARMACEUTICALS 00904624761 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL MAJOR PHARMACEUTICALS 00904624861 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL MAJOR PHARMACEUTICALS 00904626908 ZIPRASIDONE HCL 20 MG CAPSULE 47563 ZIPRASIDONE HCL MAJOR PHARMACEUTICALS 00904627008 ZIPRASIDONE HCL 40 MG CAPSULE 47564 ZIPRASIDONE HCL MAJOR PHARMACEUTICALS 00904627108 ZIPRASIDONE HCL 60 MG CAPSULE 47567 ZIPRASIDONE HCL MAJOR PHARMACEUTICALS 00904627208 ZIPRASIDONE HCL 80 MG CAPSULE 47568 ZIPRASIDONE HCL MAJOR PHARMACEUTICALS 00904627761 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE MAJOR PHARMACEUTICALS 00904627861 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE MAJOR PHARMACEUTICALS 00904627961 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE MAJOR PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 116 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 00904628061 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE MAJOR PHARMACEUTICALS 00904628161 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE MAJOR PHARMACEUTICALS 00904763661 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLMAJOR PHARMACEUTICALS 00904763761 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLMAJOR PHARMACEUTICALS 00904763861 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLMAJOR PHARMACEUTICALS 00904764960 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL MAJOR PHARMACEUTICALS 00904776560 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MAJOR PHARMACEUTICALS 00904779140 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904779160 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904779340 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904779360 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM MAJOR PHARMACEUTICALS 00904779560 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904779860 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904793960 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904794060 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904794160 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL MAJOR PHARMACEUTICALS 00904794260 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL MAJOR PHARMACEUTICALS 10019000444 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM BAXTER HEALTHCARE CORPORATION 10019000542 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM BAXTER HEALTHCARE CORPORATION 10019000567 DIAZEPAM 5 MG/ML AMPUL 3761 DIAZEPAM BAXTER HEALTHCARE CORPORATION 10019085021 DIZAC 5MG/ML AMPUL 30786 DIAZEPAM/SOYBEAN OIL BAXTER HEALTHCARE CORPORATION 10135031760 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT Marlex Pharmaceuticals, Inc. 10147091101 HALOPERIDOL 5 MG/ML AMPUL 3968 HALOPERIDOL LACTATE PATRIOT PHARMACEUTICALS, LLC. 10147092103 HALOPERIDOL DECAN 50 MG/ML AMP 3966 HALOPERIDOL DECANOATE PATRIOT PHARMACEUTICALS, LLC. 10147092205 HALOPERIDOL DEC 100 MG/ML AMP 13076 HALOPERIDOL DECANOATE PATRIOT PHARMACEUTICALS, LLC. 10267050401 ST. JOHN'S WORT 300 MG TAB 46337 ST. JOHN'S WORT CONTRACT PHARMACAL CORP 10370010100 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370010103 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370010150 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370010200 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370010203 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370010250 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370015906 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370016006 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370016010 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370016050 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370016106 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL ANCHEN PHARMACEUTICALS, INC. 10370051010 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM ANCHEN PHARMACEUTICALS, INC. 10370051050 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM ANCHEN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 117 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 10370051110 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM ANCHEN PHARMACEUTICALS, INC. 10370051150 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM ANCHEN PHARMACEUTICALS, INC. 10544030930 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 10544032930 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 10544033630 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 10544034630 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 10544034660 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 10544035430 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 10544035460 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 10544035830 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 10544040330 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 10544040390 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 10544040530 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 10544041330 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 10768706001 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 10768706003 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 10768719101 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 10768719103 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 10768761601 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 10768761603 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 10939022222 SM ST. JOHN'S WORT CAPLET 46337 ST. JOHN'S WORT MCKESSON DRUG 10939047633 SM ST. JOHN'S WORT CAPLET 46337 ST. JOHN'S WORT MCKESSON DRUG 11098001001 INAPSINE 2.5 MG/ML AMPUL 3964 DROPERIDOL TAYLOR PHARMACEUTICALS 11098001002 INAPSINE 2.5 MG/ML AMPUL 3964 DROPERIDOL TAYLOR PHARMACEUTICALS 11704060001 DIAZEPAM 10 MG/2 ML SYRINGE 3762 DIAZEPAM LABELER NOT ON FILE 11822001150 RA ST. JOHN'S WORT 300 MG TAB 46337 ST. JOHN'S WORT RITE AID CORP. 11822001160 RA ST. JOHN'S WORT 300 MG TAB 46337 ST. JOHN'S WORT RITE AID CORP. 11822219620 RA ST. JOHN'S WORT 150 MG CP 46331 ST. JOHN'S WORT RITE AID CORP. 11822881150 RA ST. JOHN'S WORT 150 MG CP 46331 ST. JOHN'S WORT RITE AID CORP. 11822881160 RA ST. JOHN'S WORT 150 MG CP 46331 ST. JOHN'S WORT RITE AID CORP. 11845013005 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT MASON DISTRIBUTORS, INC. 11845024204 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MASON DISTRIBUTORS, INC. 11845024301 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MASON DISTRIBUTORS, INC. 11845024304 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MASON DISTRIBUTORS, INC. 11845024401 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MASON DISTRIBUTORS, INC. 11845024501 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MASON DISTRIBUTORS, INC. 11845024504 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MASON DISTRIBUTORS, INC. 11845024601 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL MASON DISTRIBUTORS, INC. 11845030801 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MASON DISTRIBUTORS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 118 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 11845033701 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL MASON DISTRIBUTORS, INC. 11845033801 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL MASON DISTRIBUTORS, INC. 11845033901 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL MASON DISTRIBUTORS, INC. 11845034001 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL MASON DISTRIBUTORS, INC. 11845034003 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL MASON DISTRIBUTORS, INC. 11845034701 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MASON DISTRIBUTORS, INC. 11845035001 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL MASON DISTRIBUTORS, INC. 11845036303 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MASON DISTRIBUTORS, INC. 11845036403 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MASON DISTRIBUTORS, INC. 11845036501 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM MASON DISTRIBUTORS, INC. 11845125205 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT MASON DISTRIBUTORS, INC. 11917000644 ST. JOHN'S WORT 300 MG TABLET 46337 ST. JOHN'S WORT LABELER NOT ON FILE 12280000200 ATIVAN 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 12280000700 DESYREL 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 12280001100 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 12280001160 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 12280001415 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE LABELER NOT ON FILE 12280001615 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL LABELER NOT ON FILE 12280001715 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL LABELER NOT ON FILE 12280001815 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL LABELER NOT ON FILE 12280001915 RISPERDAL 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 12280002015 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 12280002315 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 12280002415 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 12280002430 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 12280002460 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 12280003015 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 12280003200 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 12280005600 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 12280005660 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 12280005830 ZYPREXA 20 MG TABLET 41027 OLANZAPINE LABELER NOT ON FILE 12280005860 ZYPREXA 20 MG TABLET 41027 OLANZAPINE LABELER NOT ON FILE 12280007400 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 12280016315 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 12280016330 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 12280016900 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 12280016930 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 12280017060 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL LABELER NOT ON FILE 12280017115 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 119 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 12280017130 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 12280017515 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 12280017530 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 12280021100 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 12280021900 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 12280025315 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE LABELER NOT ON FILE 12280025330 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE LABELER NOT ON FILE 12280025360 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE LABELER NOT ON FILE 12280025390 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE LABELER NOT ON FILE 12280027630 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 12280027660 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 12280027690 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 12280027730 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE LABELER NOT ON FILE 12280027760 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE LABELER NOT ON FILE 12280027790 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE LABELER NOT ON FILE 12280028015 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE LABELER NOT ON FILE 12280028060 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE LABELER NOT ON FILE 12280028215 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 12280028660 XANAX XR 1 MG TABLET 50400 ALPRAZOLAM LABELER NOT ON FILE 12280030715 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE LABELER NOT ON FILE 12280030730 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE LABELER NOT ON FILE 12280030800 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 12280030815 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 12280030830 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 12280038415 RISPERDAL 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 12280038460 RISPERDAL 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 12280039630 SEROQUEL 400 MG TABLET 60293 QUETIAPINE FUMARATE LABELER NOT ON FILE 12547043100 QUANTERRA EMOTIONAL BALANCE 46337 ST. JOHN'S WORT LABELER NOT ON FILE 13107000305 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107000330 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107000334 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107000501 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA USA, INC. 13107000505 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA USA, INC. 13107000601 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA USA, INC. 13107000605 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA USA, INC. 13107000701 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA USA, INC. 13107000705 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA USA, INC. 13107003105 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107003130 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 120 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 13107003134 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107003205 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107003230 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107003234 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA USA, INC. 13107011905 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107011960 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012005 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012060 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012105 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012160 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012205 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012260 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012305 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012360 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107012460 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE AUROBINDO PHARMA USA, INC. 13107015405 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015430 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015505 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015530 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015599 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015605 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015630 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015699 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015705 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015730 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13107015799 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AUROBINDO PHARMA USA, INC. 13668000401 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TORRENT PHARMA, INC. 13668000405 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TORRENT PHARMA, INC. 13668000410 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TORRENT PHARMA, INC. 13668000430 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TORRENT PHARMA, INC. 13668000450 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TORRENT PHARMA, INC. 13668000490 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL TORRENT PHARMA, INC. 13668000501 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TORRENT PHARMA, INC. 13668000505 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TORRENT PHARMA, INC. 13668000510 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TORRENT PHARMA, INC. 13668000530 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TORRENT PHARMA, INC. 13668000550 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TORRENT PHARMA, INC. 13668000590 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL TORRENT PHARMA, INC. 13668000601 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TORRENT PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 121 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 13668000605 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TORRENT PHARMA, INC. 13668000610 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TORRENT PHARMA, INC. 13668000630 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TORRENT PHARMA, INC. 13668000650 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TORRENT PHARMA, INC. 13668000690 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL TORRENT PHARMA, INC. 13668000901 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668000905 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668000909 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668000930 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668000974 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001001 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001005 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001006 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001030 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001074 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001101 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001105 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001108 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001130 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001174 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE TORRENT PHARMA, INC. 13668001801 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001805 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001830 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001871 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001874 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001890 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001901 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001905 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001930 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001971 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001974 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668001990 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668002001 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668002005 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668002030 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668002071 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668002074 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668002090 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL TORRENT PHARMA, INC. 13668003501 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE TORRENT PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 122 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 13668003505 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE TORRENT PHARMA, INC. 13668003560 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE TORRENT PHARMA, INC. 13668003571 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE TORRENT PHARMA, INC. 13668003574 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE TORRENT PHARMA, INC. 13668003601 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE TORRENT PHARMA, INC. 13668003605 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE TORRENT PHARMA, INC. 13668003660 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE TORRENT PHARMA, INC. 13668003671 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE TORRENT PHARMA, INC. 13668003674 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE TORRENT PHARMA, INC. 13668003701 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE TORRENT PHARMA, INC. 13668003705 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE TORRENT PHARMA, INC. 13668003760 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE TORRENT PHARMA, INC. 13668003771 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE TORRENT PHARMA, INC. 13668003774 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE TORRENT PHARMA, INC. 13668003801 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE TORRENT PHARMA, INC. 13668003805 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE TORRENT PHARMA, INC. 13668003860 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE TORRENT PHARMA, INC. 13668003871 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE TORRENT PHARMA, INC. 13668003874 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE TORRENT PHARMA, INC. 13668003901 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE TORRENT PHARMA, INC. 13668003905 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE TORRENT PHARMA, INC. 13668003960 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE TORRENT PHARMA, INC. 13668003971 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE TORRENT PHARMA, INC. 13668003974 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE TORRENT PHARMA, INC. 13668004001 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE TORRENT PHARMA, INC. 13668004005 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE TORRENT PHARMA, INC. 13668004060 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE TORRENT PHARMA, INC. 13668004064 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE TORRENT PHARMA, INC. 13668004071 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE TORRENT PHARMA, INC. 13668004501 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TORRENT PHARMA, INC. 13668004505 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TORRENT PHARMA, INC. 13668004529 LAMOTRIGINE 25 MG TB START KIT 58516 LAMOTRIGINE TORRENT PHARMA, INC. 13668004530 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TORRENT PHARMA, INC. 13668004570 LAMOTRIGINE 25 MG TB START KIT 58516 LAMOTRIGINE TORRENT PHARMA, INC. 13668004574 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TORRENT PHARMA, INC. 13668004701 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TORRENT PHARMA, INC. 13668004705 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TORRENT PHARMA, INC. 13668004730 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TORRENT PHARMA, INC. 13668004770 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TORRENT PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 123 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 13668004774 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TORRENT PHARMA, INC. 13668004801 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TORRENT PHARMA, INC. 13668004805 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TORRENT PHARMA, INC. 13668004830 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TORRENT PHARMA, INC. 13668004860 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TORRENT PHARMA, INC. 13668004864 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TORRENT PHARMA, INC. 13668004871 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TORRENT PHARMA, INC. 13668004901 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TORRENT PHARMA, INC. 13668004905 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TORRENT PHARMA, INC. 13668004930 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TORRENT PHARMA, INC. 13668004960 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TORRENT PHARMA, INC. 13668004964 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TORRENT PHARMA, INC. 13668004971 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TORRENT PHARMA, INC. 13668008630 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE TORRENT PHARMA, INC. 13668008830 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE TORRENT PHARMA, INC. 13668008930 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE TORRENT PHARMA, INC. 13668009030 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE TORRENT PHARMA, INC. 13668014801 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668014810 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668014901 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668014910 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668015001 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668015101 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668015201 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668015260 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668015301 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE TORRENT PHARMA, INC. 13668026628 LAMOTRIGINE TABLET STARTER KIT 58517 LAMOTRIGINE TORRENT PHARMA, INC. 13668026699 LAMOTRIGINE TABLET STARTER KIT 58518 LAMOTRIGINE TORRENT PHARMA, INC. 16241072001 VANSPAR 7.5 MG TABLET 47644 BUSPIRONE HCL PRX PHARMACEUTI 16241072005 VANSPAR 7.5 MG TABLET 47644 BUSPIRONE HCL PRX PHARMACEUTI 16241075901 RAPIFLUX 20 MG TABLET 46219 FLUOXETINE HCL PRX PHARMACEUTI 16252053330 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL COBALT LABORATORIES, INC. 16252053350 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL COBALT LABORATORIES, INC. 16252053430 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL COBALT LABORATORIES, INC. 16252053450 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL COBALT LABORATORIES, INC. 16252053490 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL COBALT LABORATORIES, INC. 16252053530 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL COBALT LABORATORIES, INC. 16252053550 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL COBALT LABORATORIES, INC. 16252053590 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL COBALT LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 124 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16252055860 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE COBALT LABORATORIES, INC. 16252055960 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE COBALT LABORATORIES, INC. 16252056060 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE COBALT LABORATORIES, INC. 16252056160 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE COBALT LABORATORIES, INC. 16252056260 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE COBALT LABORATORIES, INC. 16252056360 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE COBALT LABORATORIES, INC. 16252059701 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE COBALT LABORATORIES, INC. 16252059801 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE COBALT LABORATORIES, INC. 16590000515 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM STAT RX USA 16590000520 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM STAT RX USA 16590000530 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM STAT RX USA 16590000560 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM STAT RX USA 16590000572 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM STAT RX USA 16590000590 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM STAT RX USA 16590000628 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM STAT RX USA 16590000630 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM STAT RX USA 16590000660 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM STAT RX USA 16590000672 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM STAT RX USA 16590000682 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM STAT RX USA 16590000690 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM STAT RX USA 16590001130 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL STAT RX USA 16590001156 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL STAT RX USA 16590001160 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL STAT RX USA 16590001172 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL STAT RX USA 16590001190 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL STAT RX USA 16590001215 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL STAT RX USA 16590001228 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL STAT RX USA 16590001230 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL STAT RX USA 16590001260 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL STAT RX USA 16590001290 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL STAT RX USA 16590001330 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL STAT RX USA 16590001360 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL STAT RX USA 16590001390 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL STAT RX USA 16590003630 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL STAT RX USA 16590003660 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL STAT RX USA 16590003730 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL STAT RX USA 16590003760 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL STAT RX USA 16590003772 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL STAT RX USA 16590003830 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 125 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590003860 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL STAT RX USA 16590005530 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE STAT RX USA 16590005560 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE STAT RX USA 16590005590 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE STAT RX USA 16590005615 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE STAT RX USA 16590005630 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE STAT RX USA 16590005660 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE STAT RX USA 16590005690 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE STAT RX USA 16590006730 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL STAT RX USA 16590006760 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL STAT RX USA 16590006930 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM STAT RX USA 16590006960 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM STAT RX USA 16590006990 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM STAT RX USA 16590007002 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007010 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007020 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007030 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007045 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007060 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007071 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007072 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007075 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007090 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM STAT RX USA 16590007104 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007110 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007115 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007120 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007128 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007130 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007145 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007156 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007160 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007162 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590007190 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM STAT RX USA 16590008130 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL STAT RX USA 16590008160 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL STAT RX USA 16590008172 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL STAT RX USA 16590008190 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL STAT RX USA 16590008330 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 126 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590008360 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL STAT RX USA 16590008430 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL STAT RX USA 16590008460 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL STAT RX USA 16590008530 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL STAT RX USA 16590008560 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL STAT RX USA 16590008630 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590008656 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590008660 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590008690 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590008730 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590008756 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590008760 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590008772 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590008790 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590009930 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL STAT RX USA 16590009960 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL STAT RX USA 16590010030 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL STAT RX USA 16590010056 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL STAT RX USA 16590010060 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL STAT RX USA 16590010082 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL STAT RX USA 16590010090 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL STAT RX USA 16590013930 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE STAT RX USA 16590013945 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE STAT RX USA 16590013960 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE STAT RX USA 16590013990 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE STAT RX USA 16590014315 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM STAT RX USA 16590014330 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM STAT RX USA 16590014360 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM STAT RX USA 16590014372 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM STAT RX USA 16590014390 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM STAT RX USA 16590015330 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE STAT RX USA 16590015360 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE STAT RX USA 16590015430 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE STAT RX USA 16590015445 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE STAT RX USA 16590015456 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE STAT RX USA 16590015460 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE STAT RX USA 16590015530 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE STAT RX USA 16590015560 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE STAT RX USA 16590016630 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 127 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590016660 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL STAT RX USA 16590016690 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL STAT RX USA 16590017130 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL STAT RX USA 16590017160 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL STAT RX USA 16590017190 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL STAT RX USA 16590018115 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL STAT RX USA 16590018128 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL STAT RX USA 16590018130 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL STAT RX USA 16590018160 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL STAT RX USA 16590018190 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL STAT RX USA 16590019907 PROVIGIL 200 MG TABLET 41478 MODAFINIL STAT RX USA 16590019910 PROVIGIL 200 MG TABLET 41478 MODAFINIL STAT RX USA 16590019914 PROVIGIL 200 MG TABLET 41478 MODAFINIL STAT RX USA 16590019928 PROVIGIL 200 MG TABLET 41478 MODAFINIL STAT RX USA 16590019930 PROVIGIL 200 MG TABLET 41478 MODAFINIL STAT RX USA 16590019945 PROVIGIL 200 MG TABLET 41478 MODAFINIL STAT RX USA 16590019960 PROVIGIL 200 MG TABLET 41478 MODAFINIL STAT RX USA 16590023130 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL STAT RX USA 16590023145 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL STAT RX USA 16590023160 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL STAT RX USA 16590023190 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL STAT RX USA 16590023215 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL STAT RX USA 16590023228 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL STAT RX USA 16590023230 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL STAT RX USA 16590023245 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL STAT RX USA 16590023260 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL STAT RX USA 16590023290 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL STAT RX USA 16590024630 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL STAT RX USA 16590024660 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL STAT RX USA 16590024690 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL STAT RX USA 16590024930 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL STAT RX USA 16590024960 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL STAT RX USA 16590024990 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL STAT RX USA 16590025030 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL STAT RX USA 16590025060 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL STAT RX USA 16590025090 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL STAT RX USA 16590025130 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA 16590025160 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA 16590025190 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 128 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590032230 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL STAT RX USA 16590032256 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL STAT RX USA 16590032260 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL STAT RX USA 16590032272 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL STAT RX USA 16590032290 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL STAT RX USA 16590034530 NUVIGIL 150 MG TABLET 62819 ARMODAFINIL STAT RX USA 16590039430 NUVIGIL 250 MG TABLET 62821 ARMODAFINIL STAT RX USA 16590041615 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA 16590041630 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA 16590041660 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA 16590041672 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA 16590041690 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL STAT RX USA 16590043530 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL STAT RX USA 16590043730 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL STAT RX USA 16590043760 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL STAT RX USA 16590043772 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL STAT RX USA 16590043790 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL STAT RX USA 16590044720 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM STAT RX USA 16590044730 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM STAT RX USA 16590044760 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM STAT RX USA 16590044790 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM STAT RX USA 16590045715 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL STAT RX USA 16590045730 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL STAT RX USA 16590045760 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL STAT RX USA 16590045790 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL STAT RX USA 16590046830 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL STAT RX USA 16590046860 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL STAT RX USA 16590046872 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL STAT RX USA 16590046890 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL STAT RX USA 16590047430 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL STAT RX USA 16590047460 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL STAT RX USA 16590047472 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL STAT RX USA 16590047490 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL STAT RX USA 16590048030 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE STAT RX USA 16590048045 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE STAT RX USA 16590048060 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE STAT RX USA 16590048072 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE STAT RX USA 16590048090 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE STAT RX USA 16590048228 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 129 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590048230 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL STAT RX USA 16590048260 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL STAT RX USA 16590048272 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL STAT RX USA 16590048290 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL STAT RX USA 16590048328 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL STAT RX USA 16590048330 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL STAT RX USA 16590048360 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL STAT RX USA 16590048372 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL STAT RX USA 16590048390 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL STAT RX USA 16590048430 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL STAT RX USA 16590048460 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL STAT RX USA 16590048472 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL STAT RX USA 16590048490 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL STAT RX USA 16590048630 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590048660 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590048672 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590048690 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL STAT RX USA 16590048730 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590048760 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590048772 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590048790 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL STAT RX USA 16590049030 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL STAT RX USA 16590049060 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL STAT RX USA 16590049072 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL STAT RX USA 16590049090 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL STAT RX USA 16590049728 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE STAT RX USA 16590049730 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE STAT RX USA 16590049760 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE STAT RX USA 16590049772 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE STAT RX USA 16590049790 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE STAT RX USA 16590049930 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM STAT RX USA 16590049960 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM STAT RX USA 16590049972 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM STAT RX USA 16590049990 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM STAT RX USA 16590051030 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL STAT RX USA 16590051060 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL STAT RX USA 16590051072 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL STAT RX USA 16590051090 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL STAT RX USA 16590051130 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 130 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590051160 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE STAT RX USA 16590051172 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE STAT RX USA 16590051190 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE STAT RX USA 16590051230 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL STAT RX USA 16590051260 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL STAT RX USA 16590051272 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL STAT RX USA 16590051290 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL STAT RX USA 16590051330 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL STAT RX USA 16590051356 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL STAT RX USA 16590051360 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL STAT RX USA 16590051372 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL STAT RX USA 16590051390 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL STAT RX USA 16590051430 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL STAT RX USA 16590051460 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL STAT RX USA 16590051472 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL STAT RX USA 16590051490 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL STAT RX USA 16590051930 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE STAT RX USA 16590051960 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE STAT RX USA 16590051972 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE STAT RX USA 16590051990 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE STAT RX USA 16590052030 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE STAT RX USA 16590052060 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE STAT RX USA 16590052072 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE STAT RX USA 16590052090 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE STAT RX USA 16590052130 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE STAT RX USA 16590052160 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE STAT RX USA 16590052172 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE STAT RX USA 16590052190 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE STAT RX USA 16590052630 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL STAT RX USA 16590052660 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL STAT RX USA 16590052690 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL STAT RX USA 16590052930 ZYPREXA 15 MG TABLET 41026 OLANZAPINE STAT RX USA 16590052960 ZYPREXA 15 MG TABLET 41026 OLANZAPINE STAT RX USA 16590052972 ZYPREXA 15 MG TABLET 41026 OLANZAPINE STAT RX USA 16590052990 ZYPREXA 15 MG TABLET 41026 OLANZAPINE STAT RX USA 16590053530 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL STAT RX USA 16590053560 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL STAT RX USA 16590053571 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL STAT RX USA 16590053572 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 131 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590053590 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL STAT RX USA 16590055230 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL STAT RX USA 16590055260 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL STAT RX USA 16590055290 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL STAT RX USA 16590056530 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL STAT RX USA 16590056560 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL STAT RX USA 16590056572 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL STAT RX USA 16590056590 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL STAT RX USA 16590056730 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL STAT RX USA 16590056760 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL STAT RX USA 16590056790 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL STAT RX USA 16590057130 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM STAT RX USA 16590057160 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM STAT RX USA 16590057172 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM STAT RX USA 16590057190 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM STAT RX USA 16590057230 RISPERDAL 1 MG TABLET 21154 RISPERIDONE STAT RX USA 16590057260 RISPERDAL 1 MG TABLET 21154 RISPERIDONE STAT RX USA 16590057330 ABILIFY 20 MG TABLET 51335 ARIPIPRAZOLE STAT RX USA 16590057530 RISPERDAL 2 MG TABLET 21155 RISPERIDONE STAT RX USA 16590057560 RISPERDAL 2 MG TABLET 21155 RISPERIDONE STAT RX USA 16590057615 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM STAT RX USA 16590057630 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM STAT RX USA 16590057660 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM STAT RX USA 16590057672 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM STAT RX USA 16590057690 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM STAT RX USA 16590057730 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL STAT RX USA 16590057760 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL STAT RX USA 16590057790 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL STAT RX USA 16590057930 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL STAT RX USA 16590057960 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL STAT RX USA 16590058430 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM STAT RX USA 16590058460 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM STAT RX USA 16590058472 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM STAT RX USA 16590058482 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM STAT RX USA 16590058490 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM STAT RX USA 16590058560 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL STAT RX USA 16590058572 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL STAT RX USA 16590058590 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL STAT RX USA 16590058630 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 132 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590058660 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL STAT RX USA 16590058672 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL STAT RX USA 16590058690 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL STAT RX USA 16590058730 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM STAT RX USA 16590058760 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM STAT RX USA 16590058772 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM STAT RX USA 16590058790 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM STAT RX USA 16590058930 BUDEPRION XL 150 MG TABLET 53006 BUPROPION HCL STAT RX USA 16590058960 BUDEPRION XL 150 MG TABLET 53006 BUPROPION HCL STAT RX USA 16590058990 BUDEPRION XL 150 MG TABLET 53006 BUPROPION HCL STAT RX USA 16590059030 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL STAT RX USA 16590059060 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL STAT RX USA 16590059072 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL STAT RX USA 16590059090 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL STAT RX USA 16590060090 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL STAT RX USA 16590062130 ZYPREXA 5 MG TABLET 27961 OLANZAPINE STAT RX USA 16590062160 ZYPREXA 5 MG TABLET 27961 OLANZAPINE STAT RX USA 16590062190 ZYPREXA 5 MG TABLET 27961 OLANZAPINE STAT RX USA 16590063730 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL STAT RX USA 16590064130 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE STAT RX USA 16590064160 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE STAT RX USA 16590064190 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE STAT RX USA 16590064430 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL STAT RX USA 16590064460 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL STAT RX USA 16590064490 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL STAT RX USA 16590064830 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM STAT RX USA 16590064860 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM STAT RX USA 16590064890 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM STAT RX USA 16590065030 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL STAT RX USA 16590065060 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL STAT RX USA 16590065090 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL STAT RX USA 16590068160 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL STAT RX USA 16590068230 XANAX XR 2 MG TABLET 50401 ALPRAZOLAM STAT RX USA 16590068260 XANAX XR 2 MG TABLET 50401 ALPRAZOLAM STAT RX USA 16590068290 XANAX XR 2 MG TABLET 50401 ALPRAZOLAM STAT RX USA 16590071160 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL STAT RX USA 16590071190 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL STAT RX USA 16590071330 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL STAT RX USA 16590071360 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL STAT RX USA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 133 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16590071390 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL STAT RX USA 16590074530 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE STAT RX USA 16590074560 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE STAT RX USA 16590075830 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL STAT RX USA 16590075860 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL STAT RX USA 16590075960 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM STAT RX USA 16590075982 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM STAT RX USA 16590075990 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM STAT RX USA 16590076430 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL STAT RX USA 16590076690 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL STAT RX USA 16590077730 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE STAT RX USA 16590077760 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE STAT RX USA 16590078190 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE STAT RX USA 16590078230 SEROQUEL 400 MG TABLET 60293 QUETIAPINE FUMARATE STAT RX USA 16590080230 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE STAT RX USA 16590080245 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE STAT RX USA 16590080260 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE STAT RX USA 16590080472 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL STAT RX USA 16590080930 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM STAT RX USA 16590080960 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM STAT RX USA 16590080990 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM STAT RX USA 16590081372 ATIVAN 1 MG TABLET 3758 LORAZEPAM STAT RX USA 16590082272 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE STAT RX USA 16590083030 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL STAT RX USA 16590083390 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE STAT RX USA 16590084390 PROZAC 20 MG CAPSULE 46214 FLUOXETINE HCL STAT RX USA 16590084830 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL STAT RX USA 16590084860 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL STAT RX USA 16590093630 SAPHRIS 10 MG TAB SUBLINGUAL 65538 ASENAPINE MALEATE STAT RX USA 16590093760 ATIVAN 0.5 MG TABLET 3757 LORAZEPAM STAT RX USA 16590093872 NIRAVAM 0.5 MG ODT 58848 ALPRAZOLAM STAT RX USA 16590095630 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL STAT RX USA 16590096590 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL STAT RX USA 16714031101 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL NORTHSTAR RX LLC 16714031201 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL NORTHSTAR RX LLC 16714031301 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL NORTHSTAR RX LLC 16714031401 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL NORTHSTAR RX LLC 16714031501 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL NORTHSTAR RX LLC 16714033401 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL NORTHSTAR RX LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 134 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16714033402 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL NORTHSTAR RX LLC 16714033403 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL NORTHSTAR RX LLC 16714033501 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL NORTHSTAR RX LLC 16714033502 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL NORTHSTAR RX LLC 16714033503 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL NORTHSTAR RX LLC 16714033601 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL NORTHSTAR RX LLC 16714035101 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL NORTHSTAR RX LLC 16714035102 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL NORTHSTAR RX LLC 16714035103 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL NORTHSTAR RX LLC 16714035201 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL NORTHSTAR RX LLC 16714035202 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL NORTHSTAR RX LLC 16714035203 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL NORTHSTAR RX LLC 16714035301 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL NORTHSTAR RX LLC 16714035302 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL NORTHSTAR RX LLC 16714035303 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL NORTHSTAR RX LLC 16714035304 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL NORTHSTAR RX LLC 16714037102 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE NORTHSTAR RX LLC 16714037202 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE NORTHSTAR RX LLC 16714037304 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE NORTHSTAR RX LLC 16714037404 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE NORTHSTAR RX LLC 16714051101 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM NORTHSTAR RX LLC 16714051201 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM NORTHSTAR RX LLC 16714051202 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM NORTHSTAR RX LLC 16714051301 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM NORTHSTAR RX LLC 16714051302 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM NORTHSTAR RX LLC 16714060101 SERTRALINE 20 MG/ML ORAL CONC 46230 SERTRALINE HCL NORTHSTAR RX LLC 16714061101 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL NORTHSTAR RX LLC 16714061104 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL NORTHSTAR RX LLC 16714061105 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL NORTHSTAR RX LLC 16714061106 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL NORTHSTAR RX LLC 16714061201 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL NORTHSTAR RX LLC 16714061204 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL NORTHSTAR RX LLC 16714061205 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL NORTHSTAR RX LLC 16714061206 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL NORTHSTAR RX LLC 16714061301 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL NORTHSTAR RX LLC 16714061304 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL NORTHSTAR RX LLC 16714061305 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL NORTHSTAR RX LLC 16714061306 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL NORTHSTAR RX LLC 16729014501 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 135 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 16729014517 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014601 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014617 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014701 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014717 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014800 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014817 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014912 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729014917 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729015000 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 16729015016 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE ACCORD HEALTHCARE INCORPORATED 17224080510 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE LABELER NOT ON FILE 17236000301 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL R & S NORTHEAST LLC 17236000501 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL R & S NORTHEAST LLC 17236000601 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL R & S NORTHEAST LLC 17236000701 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL R & S NORTHEAST LLC 17236029301 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236029310 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236029601 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236029610 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236030101 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL R & S NORTHEAST LLC 17236030110 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL R & S NORTHEAST LLC 17236030201 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL R & S NORTHEAST LLC 17236030210 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL R & S NORTHEAST LLC 17236030501 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL R & S NORTHEAST LLC 17236030510 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL R & S NORTHEAST LLC 17236031801 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL R & S NORTHEAST LLC 17236031810 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL R & S NORTHEAST LLC 17236033401 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236033405 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236033410 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236035601 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL R & S NORTHEAST LLC 17236035610 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL R & S NORTHEAST LLC 17236035611 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL R & S NORTHEAST LLC 17236035701 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL R & S NORTHEAST LLC 17236035710 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL R & S NORTHEAST LLC 17236035711 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL R & S NORTHEAST LLC 17236035801 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL R & S NORTHEAST LLC 17236035810 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL R & S NORTHEAST LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 136 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 17236035811 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL R & S NORTHEAST LLC 17236035901 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL R & S NORTHEAST LLC 17236035910 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL R & S NORTHEAST LLC 17236035911 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL R & S NORTHEAST LLC 17236037501 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL R & S NORTHEAST LLC 17236037510 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL R & S NORTHEAST LLC 17236037511 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL R & S NORTHEAST LLC 17236037901 TRIFLUOPERAZINE 1MG TABLET 3851 TRIFLUOPERAZINE HCL R & S NORTHEAST LLC 17236046501 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE R & S NORTHEAST LLC 17236046511 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE R & S NORTHEAST LLC 17236046601 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE R & S NORTHEAST LLC 17236046610 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE R & S NORTHEAST LLC 17236046611 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE R & S NORTHEAST LLC 17236046701 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE R & S NORTHEAST LLC 17236046710 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE R & S NORTHEAST LLC 17236046711 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE R & S NORTHEAST LLC 17236046801 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE R & S NORTHEAST LLC 17236046810 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE R & S NORTHEAST LLC 17236046811 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE R & S NORTHEAST LLC 17236048901 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236048905 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236048911 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049001 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049005 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049011 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049101 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049105 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049111 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049201 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049205 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236049211 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL R & S NORTHEAST LLC 17236065501 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL R & S NORTHEAST LLC 17236065505 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL R & S NORTHEAST LLC 17236069401 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE R & S NORTHEAST LLC 17236069501 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE R & S NORTHEAST LLC 17236069601 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE R & S NORTHEAST LLC 17236069801 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE R & S NORTHEAST LLC 17236080701 FLUOXETINE 10 MG CAPSULE 46213 FLUOXETINE HCL R & S NORTHEAST LLC 17236080710 FLUOXETINE 10 MG CAPSULE 46213 FLUOXETINE HCL R & S NORTHEAST LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 137 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 17236080801 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL R & S NORTHEAST LLC 17236080810 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL R & S NORTHEAST LLC 17236088801 AMOXAPINE 25MG TABLET 46083 AMOXAPINE R & S NORTHEAST LLC 17236088901 AMOXAPINE 50MG TABLET 46084 AMOXAPINE R & S NORTHEAST LLC 17236089001 AMOXAPINE 100MG TABLET 46081 AMOXAPINE R & S NORTHEAST LLC 17236089103 AMOXAPINE 150MG TABLET 46082 AMOXAPINE R & S NORTHEAST LLC 18261073045 KIRA ST. JOHN'S WORT TABLET 46337 ST. JOHN'S WORT LABELER NOT ON FILE 18837000130 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 18837000160 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 18837000190 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 18837000230 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 18837000260 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 18837000290 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 18837000298 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 18837000398 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 18837000630 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000660 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000690 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000830 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000860 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000890 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000898 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000930 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837000960 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837003430 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 18837003460 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 18837003530 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 18837003560 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 18837003830 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 18837003860 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 18837003890 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 18837003898 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 18837003903 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 18837003930 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 18837003960 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 18837003990 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 18837004430 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 18837004530 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 18837004630 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 138 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 18837004730 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 18837004760 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 18837004790 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 18837004830 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 18837004860 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 18837004930 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 18837004940 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 18837004960 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 18837004990 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 18837005430 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 18837005460 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 18837005490 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 18837007630 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 18837007660 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 18837007730 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 18837007760 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 18837009430 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 18837011430 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 18837011460 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 18837013030 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 18837013060 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 18837014330 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 18837014360 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 18837016030 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 18837016060 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 18837016230 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 18837016260 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 18837022230 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 18837024630 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 18837024660 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 18837024830 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 18837024860 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 18837024890 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 18837024930 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 18837024960 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 18837025230 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 18837025330 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 18837025390 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 18837027830 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 139 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 18837027960 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 18837028130 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 18837028160 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 18837028730 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 18837029530 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 18837029830 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 18837030345 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 18837030390 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 18837030430 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 18837031030 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 18837031060 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 18837032860 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 18837034130 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 18837034430 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 18837034830 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL LABELER NOT ON FILE 18837035430 BUDEPRION XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 18837035460 BUDEPRION XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 18837036490 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 18837037630 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 18860010110 FAZACLO 12.5 MG ODT 63031 CLOZAPINE AZUR PHARMA, INC. 18860010201 FAZACLO 25 MG ODT 53994 CLOZAPINE AZUR PHARMA, INC. 18860010210 FAZACLO 25 MG ODT 53994 CLOZAPINE AZUR PHARMA, INC. 18860010401 FAZACLO 100 MG ODT 53995 CLOZAPINE AZUR PHARMA, INC. 18860010410 FAZACLO 100 MG ODT 53995 CLOZAPINE AZUR PHARMA, INC. 18860010501 FAZACLO 150 MG ODT 66557 CLOZAPINE AZUR PHARMA, INC. 18860010510 FAZACLO 150 MG ODT 66557 CLOZAPINE AZUR PHARMA, INC. 18860010601 FAZACLO 200 MG ODT 66558 CLOZAPINE AZUR PHARMA, INC. 18860010610 FAZACLO 200 MG ODT 66558 CLOZAPINE AZUR PHARMA, INC. 18860032101 NIRAVAM 0.25 MG ODT 58847 ALPRAZOLAM AZUR PHARMA, INC. 18860032201 NIRAVAM 0.5 MG ODT 58848 ALPRAZOLAM AZUR PHARMA, INC. 18860032301 NIRAVAM 1 MG ODT 58849 ALPRAZOLAM AZUR PHARMA, INC. 18860032401 NIRAVAM 2 MG ODT 58850 ALPRAZOLAM AZUR PHARMA, INC. 20525012013 ST. JOHN'S WORT 300 MG CAP 46333 ST. JOHN'S WORT LABELER NOT ON FILE 20525012201 ST. JOHN'S WORT 600 MG CAP 46336 ST. JOHN'S WORT LABELER NOT ON FILE 21695000215 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE PHYSICIAN PARTN 21695000230 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE PHYSICIAN PARTN 21695000315 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE PHYSICIAN PARTN 21695000330 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE PHYSICIAN PARTN 21695000345 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 140 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695000415 ABILIFY 15 MG TABLET 51334 ARIPIPRAZOLE PHYSICIAN PARTN 21695000530 ABILIFY 20 MG TABLET 51335 ARIPIPRAZOLE PHYSICIAN PARTN 21695001700 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PHYSICIAN PARTN 21695001730 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PHYSICIAN PARTN 21695001760 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PHYSICIAN PARTN 21695001800 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIAN PARTN 21695001830 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIAN PARTN 21695001860 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIAN PARTN 21695001890 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIAN PARTN 21695001930 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIAN PARTN 21695001960 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIAN PARTN 21695002060 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL PHYSICIAN PARTN 21695003000 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003030 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003060 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003090 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003100 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003130 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003160 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003190 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003200 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003230 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003260 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695003290 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN 21695004515 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL PHYSICIAN PARTN 21695004615 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695004630 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695004645 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695004660 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695004690 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695004715 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHYSICIAN PARTN 21695004745 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHYSICIAN PARTN 21695005220 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHYSICIAN PARTN 21695005230 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHYSICIAN PARTN 21695005260 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHYSICIAN PARTN 21695005290 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHYSICIAN PARTN 21695005330 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIAN PARTN 21695005360 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIAN PARTN 21695005390 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 141 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695005407 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PHYSICIAN PARTN 21695005430 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PHYSICIAN PARTN 21695005460 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PHYSICIAN PARTN 21695005490 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PHYSICIAN PARTN 21695006010 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL PHYSICIAN PARTN 21695006015 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL PHYSICIAN PARTN 21695006045 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL PHYSICIAN PARTN 21695006115 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL PHYSICIAN PARTN 21695006145 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL PHYSICIAN PARTN 21695006260 GEODON 60 MG CAPSULE 47567 ZIPRASIDONE HCL PHYSICIAN PARTN 21695006360 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL PHYSICIAN PARTN 21695007260 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE PHYSICIAN PARTN 21695007315 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIAN PARTN 21695007330 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIAN PARTN 21695007345 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIAN PARTN 21695007415 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIAN PARTN 21695007430 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIAN PARTN 21695007445 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIAN PARTN 21695008100 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PHYSICIAN PARTN 21695008130 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PHYSICIAN PARTN 21695008160 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PHYSICIAN PARTN 21695008190 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PHYSICIAN PARTN 21695008200 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PHYSICIAN PARTN 21695008230 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PHYSICIAN PARTN 21695008260 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PHYSICIAN PARTN 21695008330 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PHYSICIAN PARTN 21695008760 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE PHYSICIAN PARTN 21695008960 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE PHYSICIAN PARTN 21695009300 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695009330 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695009360 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695009390 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695009430 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695009460 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695009490 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695009560 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE PHYSICIAN PARTN 21695009660 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE PHYSICIAN PARTN 21695010130 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PHYSICIAN PARTN 21695010160 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 142 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695010190 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PHYSICIAN PARTN 21695010230 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIAN PARTN 21695010260 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIAN PARTN 21695010290 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIAN PARTN 21695010330 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PHYSICIAN PARTN 21695010390 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PHYSICIAN PARTN 21695010430 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PHYSICIAN PARTN 21695010460 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PHYSICIAN PARTN 21695010490 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PHYSICIAN PARTN 21695010760 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE PHYSICIAN PARTN 21695011315 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PHYSICIAN PARTN 21695011530 RISPERDAL 3 MG TABLET 21156 RISPERIDONE PHYSICIAN PARTN 21695011560 RISPERDAL 3 MG TABLET 21156 RISPERIDONE PHYSICIAN PARTN 21695011715 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PHYSICIAN PARTN 21695011815 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE PHYSICIAN PARTN 21695011915 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PHYSICIAN PARTN 21695011930 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PHYSICIAN PARTN 21695012015 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PHYSICIAN PARTN 21695013330 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIAN PARTN 21695013360 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIAN PARTN 21695013372 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIAN PARTN 21695013390 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIAN PARTN 21695013430 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHYSICIAN PARTN 21695013460 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHYSICIAN PARTN 21695013490 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHYSICIAN PARTN 21695013530 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHYSICIAN PARTN 21695013560 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHYSICIAN PARTN 21695013590 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHYSICIAN PARTN 21695013715 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIAN PARTN 21695013730 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIAN PARTN 21695013745 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIAN PARTN 21695013815 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL PHYSICIAN PARTN 21695013830 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL PHYSICIAN PARTN 21695014030 ZYPREXA 5 MG TABLET 27961 OLANZAPINE PHYSICIAN PARTN 21695014160 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE PHYSICIAN PARTN 21695014215 ZYPREXA 10 MG TABLET 27960 OLANZAPINE PHYSICIAN PARTN 21695014430 ZYPREXA 20 MG TABLET 41027 OLANZAPINE PHYSICIAN PARTN 21695014515 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL PHYSICIAN PARTN 21695014530 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 143 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695014615 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIAN PARTN 21695014630 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIAN PARTN 21695014660 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIAN PARTN 21695014690 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIAN PARTN 21695015915 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL PHYSICIAN PARTN 21695015930 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL PHYSICIAN PARTN 21695016030 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL PHYSICIAN PARTN 21695016130 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE PHYSICIAN PARTN 21695016315 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM PHYSICIAN PARTN 21695016430 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PHYSICIAN PARTN 21695016530 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIAN PARTN 21695016560 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIAN PARTN 21695016590 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIAN PARTN 21695016630 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIAN PARTN 21695016660 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIAN PARTN 21695016690 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIAN PARTN 21695017200 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIAN PARTN 21695017260 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIAN PARTN 21695017460 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL PHYSICIAN PARTN 21695017560 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL PHYSICIAN PARTN 21695017630 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PHYSICIAN PARTN 21695017660 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PHYSICIAN PARTN 21695017730 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL PHYSICIAN PARTN 21695017760 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL PHYSICIAN PARTN 21695019530 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL PHYSICIAN PARTN 21695019560 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL PHYSICIAN PARTN 21695021714 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIAN PARTN 21695021730 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIAN PARTN 21695021760 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIAN PARTN 21695021790 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIAN PARTN 21695022315 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE PHYSICIAN PARTN 21695022330 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE PHYSICIAN PARTN 21695022360 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE PHYSICIAN PARTN 21695022415 LAMICTAL 150 MG TABLET 22550 LAMOTRIGINE PHYSICIAN PARTN 21695022730 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE PHYSICIAN PARTN 21695022760 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE PHYSICIAN PARTN 21695022830 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE PHYSICIAN PARTN 21695022860 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE PHYSICIAN PARTN 21695022960 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 144 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695023415 PROVIGIL 100 MG TABLET 25848 MODAFINIL PHYSICIAN PARTN 21695023430 PROVIGIL 100 MG TABLET 25848 MODAFINIL PHYSICIAN PARTN 21695023515 PROVIGIL 200 MG TABLET 41478 MODAFINIL PHYSICIAN PARTN 21695023530 PROVIGIL 200 MG TABLET 41478 MODAFINIL PHYSICIAN PARTN 21695023800 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIAN PARTN 21695023804 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIAN PARTN 21695023815 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIAN PARTN 21695023830 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIAN PARTN 21695023860 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIAN PARTN 21695023890 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIAN PARTN 21695023900 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIAN PARTN 21695023903 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIAN PARTN 21695023910 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIAN PARTN 21695023915 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIAN PARTN 21695023930 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIAN PARTN 21695023960 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIAN PARTN 21695023990 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIAN PARTN 21695024003 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIAN PARTN 21695024030 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIAN PARTN 21695024060 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIAN PARTN 21695024720 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIAN PARTN 21695024730 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIAN PARTN 21695024760 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIAN PARTN 21695024790 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIAN PARTN 21695024800 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIAN PARTN 21695024815 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIAN PARTN 21695024820 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIAN PARTN 21695024830 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIAN PARTN 21695024860 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIAN PARTN 21695024930 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIAN PARTN 21695024940 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIAN PARTN 21695024945 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIAN PARTN 21695024960 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIAN PARTN 21695024990 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIAN PARTN 21695025030 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIAN PARTN 21695025040 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIAN PARTN 21695025060 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIAN PARTN 21695025090 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIAN PARTN 21695025120 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 145 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695025130 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025160 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025190 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025230 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025260 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025290 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025330 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025360 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025390 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695025660 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PHYSICIAN PARTN 21695025690 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PHYSICIAN PARTN 21695026330 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHYSICIAN PARTN 21695026390 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHYSICIAN PARTN 21695026402 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026410 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026412 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026415 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026420 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026430 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026445 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026460 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026490 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIAN PARTN 21695026505 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIAN PARTN 21695026515 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIAN PARTN 21695026530 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIAN PARTN 21695026540 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIAN PARTN 21695026545 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIAN PARTN 21695026560 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIAN PARTN 21695026590 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIAN PARTN 21695027930 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIAN PARTN 21695027960 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIAN PARTN 21695027990 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIAN PARTN 21695029560 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL PHYSICIAN PARTN 21695029615 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695029645 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695032000 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PHYSICIAN PARTN 21695032090 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PHYSICIAN PARTN 21695032100 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PHYSICIAN PARTN 21695032130 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 146 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695032160 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PHYSICIAN PARTN 21695032190 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PHYSICIAN PARTN 21695035930 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM PHYSICIAN PARTN 21695041200 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE PHYSICIAN PARTN 21695041230 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE PHYSICIAN PARTN 21695041290 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE PHYSICIAN PARTN 21695041460 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE PHYSICIAN PARTN 21695041560 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE PHYSICIAN PARTN 21695041700 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PHYSICIAN PARTN 21695041730 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PHYSICIAN PARTN 21695041760 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PHYSICIAN PARTN 21695042800 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PHYSICIAN PARTN 21695042828 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PHYSICIAN PARTN 21695042830 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PHYSICIAN PARTN 21695043356 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIAN PARTN 21695043360 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIAN PARTN 21695043390 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIAN PARTN 21695043460 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PHYSICIAN PARTN 21695044130 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PHYSICIAN PARTN 21695044630 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695044660 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695044690 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIAN PARTN 21695045530 INVEGA ER 6 MG TABLET 61986 PALIPERIDONE PHYSICIAN PARTN 21695046590 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIAN PARTN 21695055230 PAROXETINE CR 12.5 MG TABLET 50137 PAROXETINE HCL PHYSICIAN PARTN 21695057730 BUDEPRION SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIAN PARTN 21695057830 BUDEPRION XL 300 MG TABLET 53007 BUPROPION HCL PHYSICIAN PARTN 21695059630 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PHYSICIAN PARTN 21695059930 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695059960 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695059990 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695060030 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL PHYSICIAN PARTN 21695060260 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM PHYSICIAN PARTN 21695060360 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM PHYSICIAN PARTN 21695060460 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM PHYSICIAN PARTN 21695060560 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM PHYSICIAN PARTN 21695064130 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL PHYSICIAN PARTN 21695065360 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL PHYSICIAN PARTN 21695065530 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIAN PARTN

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 147 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 21695065760 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL PHYSICIAN PARTN 21695071530 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL PHYSICIAN PARTN 21695071560 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL PHYSICIAN PARTN 21695071630 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIAN PARTN 21695071930 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIAN PARTN 21695071960 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIAN PARTN 21695071990 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIAN PARTN 21695072060 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL PHYSICIAN PARTN 21695081760 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM PHYSICIAN PARTN 21695081830 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM PHYSICIAN PARTN 21695081860 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM PHYSICIAN PARTN 21695081930 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PHYSICIAN PARTN 21695081960 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PHYSICIAN PARTN 21695081990 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PHYSICIAN PARTN 21695084560 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL PHYSICIAN PARTN 21695088910 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIAN PARTN 21695094330 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PHYSICIAN PARTN 21695095730 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL PHYSICIAN PARTN 21695095830 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695095890 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PHYSICIAN PARTN 21695096130 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL PHYSICIAN PARTN 23155012801 MEPROBAMATE 200 MG TABLET 3713 MEPROBAMATE HERITAGE PHARMACEUTICALS, INC. 23155012901 MEPROBAMATE 400 MG TABLET 3714 MEPROBAMATE HERITAGE PHARMACEUTICALS, INC. 23360001001 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE AKORN STRIDES 23490503201 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PALMETTO STATE 23490503202 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PALMETTO STATE 23490503204 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PALMETTO STATE 23490503205 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PALMETTO STATE 23490503206 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PALMETTO STATE 23490503207 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PALMETTO STATE 23490503401 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PALMETTO STATE 23490503402 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PALMETTO STATE 23490503403 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PALMETTO STATE 23490503404 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PALMETTO STATE 23490503503 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PALMETTO STATE 23490503506 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PALMETTO STATE 23490503508 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PALMETTO STATE 23490503509 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PALMETTO STATE 23490504700 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PALMETTO STATE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 148 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 23490504701 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PALMETTO STATE 23490504702 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PALMETTO STATE 23490504703 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PALMETTO STATE 23490504704 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PALMETTO STATE 23490505000 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PALMETTO STATE 23490505001 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PALMETTO STATE 23490505004 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PALMETTO STATE 23490505005 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PALMETTO STATE 23490505006 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PALMETTO STATE 23490505008 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PALMETTO STATE 23490505009 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PALMETTO STATE 23490505101 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PALMETTO STATE 23490505102 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PALMETTO STATE 23490505103 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PALMETTO STATE 23490505203 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL PALMETTO STATE 23490517203 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PALMETTO STATE 23490517206 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PALMETTO STATE 23490517303 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PALMETTO STATE 23490517401 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PALMETTO STATE 23490517409 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PALMETTO STATE 23490526103 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM PALMETTO STATE 23490526203 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PALMETTO STATE 23490526303 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PALMETTO STATE 23490526601 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PALMETTO STATE 23490526701 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PALMETTO STATE 23490526702 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PALMETTO STATE 23490526703 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PALMETTO STATE 23490539101 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL PALMETTO STATE 23490539201 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL PALMETTO STATE 23490539301 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PALMETTO STATE 23490539302 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PALMETTO STATE 23490539401 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL PALMETTO STATE 23490539402 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL PALMETTO STATE 23490539403 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL PALMETTO STATE 23490541800 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE 23490541801 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE 23490541802 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE 23490541803 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE 23490541804 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 149 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 23490541805 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE 23490541806 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE 23490541807 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PALMETTO STATE 23490541901 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PALMETTO STATE 23490541903 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PALMETTO STATE 23490542001 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PALMETTO STATE 23490542002 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PALMETTO STATE 23490542003 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PALMETTO STATE 23490542004 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PALMETTO STATE 23490542005 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PALMETTO STATE 23490542006 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PALMETTO STATE 23490542007 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PALMETTO STATE 23490548003 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PALMETTO STATE 23490560103 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PALMETTO STATE 23490560201 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PALMETTO STATE 23490560202 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PALMETTO STATE 23490560203 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PALMETTO STATE 23490583400 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PALMETTO STATE 23490583401 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PALMETTO STATE 23490583501 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PALMETTO STATE 23490583502 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PALMETTO STATE 23490583503 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PALMETTO STATE 23490583504 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PALMETTO STATE 23490583600 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PALMETTO STATE 23490583601 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PALMETTO STATE 23490583602 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PALMETTO STATE 23490601901 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PALMETTO STATE 23490601902 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PALMETTO STATE 23490601903 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PALMETTO STATE 23490601904 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PALMETTO STATE 23490602001 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PALMETTO STATE 23490602002 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PALMETTO STATE 23490602003 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PALMETTO STATE 23490602106 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PALMETTO STATE 23490605901 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PALMETTO STATE 23490605902 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PALMETTO STATE 23490605903 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PALMETTO STATE 23490606001 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PALMETTO STATE 23490606002 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PALMETTO STATE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 150 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 23490626301 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PALMETTO STATE 23490626302 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PALMETTO STATE 23490626303 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PALMETTO STATE 23490626401 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PALMETTO STATE 23490626402 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PALMETTO STATE 23490626403 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PALMETTO STATE 23490626404 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PALMETTO STATE 23490640501 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PALMETTO STATE 23490640502 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PALMETTO STATE 23490640509 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PALMETTO STATE 23490640601 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PALMETTO STATE 23490640602 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PALMETTO STATE 23490640606 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PALMETTO STATE 23490640609 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PALMETTO STATE 23490640701 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PALMETTO STATE 23490640702 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PALMETTO STATE 23490640703 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PALMETTO STATE 23490640704 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PALMETTO STATE 23490653006 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PALMETTO STATE 23490657701 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL PALMETTO STATE 23490657901 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PALMETTO STATE 23490657902 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PALMETTO STATE 23490657903 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PALMETTO STATE 23490694701 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PALMETTO STATE 23490694702 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PALMETTO STATE 23490694801 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PALMETTO STATE 23490694802 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PALMETTO STATE 23490694803 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PALMETTO STATE 23490698901 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PALMETTO STATE 23490698902 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PALMETTO STATE 23490699003 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PALMETTO STATE 23490705001 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PALMETTO STATE 23490705002 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PALMETTO STATE 23490722501 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722502 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722503 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722504 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722505 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722509 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PALMETTO STATE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 151 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 23490722603 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722605 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722606 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490722609 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490729303 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PALMETTO STATE 23490732703 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PALMETTO STATE 23490755801 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490755802 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490755803 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PALMETTO STATE 23490768903 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PALMETTO STATE 23490768906 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PALMETTO STATE 23490921000 REMERON 15 MG SOLTAB 47453 MIRTAZAPINE PALMETTO STATE 23490921003 REMERON 15 MG SOLTAB 47453 MIRTAZAPINE PALMETTO STATE 23490922000 REMERON 15 MG TABLET 46450 MIRTAZAPINE PALMETTO STATE 23490922003 REMERON 15 MG TABLET 46450 MIRTAZAPINE PALMETTO STATE 23490923006 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PALMETTO STATE 23490923103 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL PALMETTO STATE 23490923203 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL PALMETTO STATE 23629003501 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL CHOICE RX US LL 23629003510 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL CHOICE RX US LL 23629004401 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE CHOICE RX US LL 23629004410 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE CHOICE RX US LL 23629005801 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE CHOICE RX US LL 23629005810 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE CHOICE RX US LL 23629005901 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE CHOICE RX US LL 23629005910 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE CHOICE RX US LL 23629008410 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CHOICE RX US LL 23629008510 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CHOICE RX US LL 23629010610 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CHOICE RX US LL 23629014910 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CHOICE RX US LL 23629017310 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL CHOICE RX US LL 24385095371 ST. JOHN'S WORT 150MG CAP 46331 ST. JOHN'S WORT BERGEN BRUNSWIG DRUG COMPANY 24385097271 ST. JOHN'S WORT 300 MG CPLT 46337 ST. JOHN'S WORT BERGEN BRUNSWIG DRUG COMPANY 24658014001 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 24658014010 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 24658014030 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 24658014101 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 24658014110 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 24658014130 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 152 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 24658014201 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 24658014210 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 24658014230 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE BLU PHARMACEUTICALS 25021080601 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE SAGENT PHARMACEUTICALS, INC. 25021082310 HALOPERIDOL LAC 50 MG/10 ML VL 3970 HALOPERIDOL LACTATE SAGENT PHARMACEUTICALS, INC. 29300013801 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM UNICHEM PHARMACEUTICALS, INC. 29300013805 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM UNICHEM PHARMACEUTICALS, INC. 29300013901 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UNICHEM PHARMACEUTICALS, INC. 29300013905 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UNICHEM PHARMACEUTICALS, INC. 29300014001 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UNICHEM PHARMACEUTICALS, INC. 29300014005 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UNICHEM PHARMACEUTICALS, INC. 30698003201 MARPLAN 10 MG TABLET 46262 ISOCARBOXAZID VALIDUS PHARMACEUTICALS, INC. 30698041912 EQUETRO 100 MG CAPSULE 64364 CARBAMAZEPINE VALIDUS PHARMACEUTICALS, INC. 30698042112 EQUETRO 200 MG CAPSULE 64365 CARBAMAZEPINE VALIDUS PHARMACEUTICALS, INC. 30698042312 EQUETRO 300 MG CAPSULE 64366 CARBAMAZEPINE VALIDUS PHARMACEUTICALS, INC. 31604014156 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT LABELER NOT ON FILE 31604014231 ST. JOHN'S WORT 150 MG CAPSULE 46331 ST. JOHN'S WORT LABELER NOT ON FILE 31604014232 ST. JOHN'S WORT 150 MG CAPSULE 46331 ST. JOHN'S WORT LABELER NOT ON FILE 31722020601 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020605 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020610 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020701 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020705 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020710 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020801 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020805 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722020810 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CAMBER PHARMACEUTICALS, INC. 31722021205 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021230 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021290 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021305 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021330 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021390 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021405 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021430 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722021490 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL CAMBER PHARMACEUTICALS, INC. 31722054401 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE CAMBER PHARMACEUTICALS, INC. 31722054501 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE CAMBER PHARMACEUTICALS, INC. 31722054510 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE CAMBER PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 153 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 31722054601 LITHIUM CARBONATE 600 MG CAP 4002 LITHIUM CARBONATE CAMBER PHARMACEUTICALS, INC. 33358001430 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 33358001460 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 33358001520 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 33358001530 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 33358001540 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 33358001560 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 33358001590 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 33358001600 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 33358001610 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 33358001620 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 33358001630 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 33358001640 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 33358001660 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 33358001740 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 33358001760 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 33358001790 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 33358002215 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002230 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002260 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002300 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002320 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002330 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002360 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002400 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002430 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358002460 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 33358005230 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL LABELER NOT ON FILE 33358005360 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL LABELER NOT ON FILE 33358005430 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 33358005490 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 33358005510 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 33358005560 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 33358005630 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 33358005730 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL LABELER NOT ON FILE 33358005760 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL LABELER NOT ON FILE 33358008230 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 33358008260 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 33358008290 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 154 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 33358008330 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 33358008360 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 33358008430 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 33358008460 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 33358009830 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 33358009860 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 33358009930 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 33358009960 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 33358010030 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM LABELER NOT ON FILE 33358010060 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM LABELER NOT ON FILE 33358010130 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 33358010212 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 33358010215 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 33358010220 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 33358010230 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 33358010260 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 33358010290 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 33358010300 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 33358010320 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 33358010330 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 33358010340 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 33358010350 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 33358010360 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 33358010390 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 33358011730 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 33358011760 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 33358011830 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 33358011860 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 33358011930 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 33358011960 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 33358012330 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 33358012360 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 33358012390 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 33358014430 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 33358014460 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 33358014490 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 33358014530 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 33358014560 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 33358018930 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 155 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 33358018960 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 33358019030 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 33358019060 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 33358019130 IMIPRAMINE PAMOATE 75 MG CAP 46078 IMIPRAMINE PAMOATE LABELER NOT ON FILE 33358020830 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE LABELER NOT ON FILE 33358020930 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 33358021530 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 33358021560 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 33358021930 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 33358021960 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 33358022003 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 33358022014 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 33358022015 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 33358022030 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 33358022050 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 33358022060 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 33358022090 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 33358022130 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 33358022160 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 33358026300 NIRAVAM 0.25 MG ODT 58847 ALPRAZOLAM LABELER NOT ON FILE 33358026400 NIRAVAM 0.5 MG ODT 58848 ALPRAZOLAM LABELER NOT ON FILE 33358027030 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 33358027060 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 33358027090 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 33358027101 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 33358027130 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 33358027160 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 33358028330 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 33358028360 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 33358028390 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 33358031830 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE LABELER NOT ON FILE 33358031860 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE LABELER NOT ON FILE 33358032030 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 33358032060 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 33358032130 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 33358032160 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 33358032190 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 33358032230 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 33358032260 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 156 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 33358032290 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 33358032330 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 33358032360 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 33358032390 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 33358034420 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 33358034430 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 33358034460 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 33358034530 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 33358034590 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 33358034630 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 33358034660 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 33358034690 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 33358036360 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL LABELER NOT ON FILE 33358036430 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 33358036460 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 33358036490 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 33358036530 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 35356000600 VALIUM 10 MG TABLET 3766 DIAZEPAM QUALITY CARE 35356001300 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM QUALITY CARE 35356002200 VALIUM 5 MG TABLET 3768 DIAZEPAM QUALITY CARE 35356002830 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE QUALITY CARE 35356002930 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE QUALITY CARE 35356003030 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE QUALITY CARE 35356003130 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE QUALITY CARE 35356003230 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE QUALITY CARE 35356003330 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL QUALITY CARE 35356004530 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE QUALITY CARE 35356004630 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE QUALITY CARE 35356008600 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE QUALITY CARE 35356008630 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE QUALITY CARE 35356008730 BUDEPRION XL 300 MG TABLET 53007 BUPROPION HCL QUALITY CARE 35356008760 BUDEPRION XL 300 MG TABLET 53007 BUPROPION HCL QUALITY CARE 35356008790 BUDEPRION XL 300 MG TABLET 53007 BUPROPION HCL QUALITY CARE 35356009560 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL QUALITY CARE 35356009660 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE QUALITY CARE 35356009760 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL QUALITY CARE 35356009890 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL QUALITY CARE 35356010660 RISPERDAL 3 MG TABLET 21156 RISPERIDONE QUALITY CARE 35356014130 STRATTERA 18 MG CAPSULE 51490 ATOMOXETINE HCL QUALITY CARE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 157 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 35356014230 STRATTERA 40 MG CAPSULE 51492 ATOMOXETINE HCL QUALITY CARE 35356014290 STRATTERA 40 MG CAPSULE 51492 ATOMOXETINE HCL QUALITY CARE 35356016200 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE QUALITY CARE 35356016230 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE QUALITY CARE 35356016290 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE QUALITY CARE 35356017020 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM QUALITY CARE 35356017130 ABILIFY 30 MG TABLET 51336 ARIPIPRAZOLE QUALITY CARE 35356017200 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE QUALITY CARE 35356017260 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE QUALITY CARE 35356017360 LAMICTAL 200 MG TABLET 22551 LAMOTRIGINE QUALITY CARE 35356020360 LAMICTAL 150 MG TABLET 22550 LAMOTRIGINE QUALITY CARE 35356020460 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE QUALITY CARE 35356025130 SEROQUEL XR 400 MG TABLET 62750 QUETIAPINE FUMARATE QUALITY CARE 35356026100 SEROQUEL 400 MG TABLET 60293 QUETIAPINE FUMARATE QUALITY CARE 35356026130 SEROQUEL 400 MG TABLET 60293 QUETIAPINE FUMARATE QUALITY CARE 35356027460 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL QUALITY CARE 35356031630 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE QUALITY CARE 35356031730 ZYPREXA 15 MG TABLET 41026 OLANZAPINE QUALITY CARE 35356031830 ZYPREXA 20 MG TABLET 41027 OLANZAPINE QUALITY CARE 35356031930 ZYPREXA ZYDIS 5 MG TABLET 45190 OLANZAPINE QUALITY CARE 35356032030 ZYPREXA ZYDIS 10 MG TABLET 45191 OLANZAPINE QUALITY CARE 35356032130 ZYPREXA ZYDIS 15 MG TABLET 47285 OLANZAPINE QUALITY CARE 35356032230 ZYPREXA ZYDIS 20 MG TABLET 47286 OLANZAPINE QUALITY CARE 35356034500 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM QUALITY CARE 35356034630 PAXIL 40 MG TABLET 46225 PAROXETINE HCL QUALITY CARE 35356035330 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL QUALITY CARE 35356035420 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL QUALITY CARE 35356036960 PAMELOR 50 MG CAPSULE 46061 NORTRIPTYLINE HCL QUALITY CARE 35356037102 DIAZEPAM 5 MG/ML SYRINGE 3762 DIAZEPAM QUALITY CARE 35356037110 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM QUALITY CARE 35356037230 PROVIGIL 200 MG TABLET 41478 MODAFINIL QUALITY CARE 35356037530 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL QUALITY CARE 35356038530 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL QUALITY CARE 35356038630 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM QUALITY CARE 35356042460 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL QUALITY CARE 35356044030 SEROQUEL XR 200 MG TABLET 62748 QUETIAPINE FUMARATE QUALITY CARE 35356044130 SEROQUEL XR 300 MG TABLET 62749 QUETIAPINE FUMARATE QUALITY CARE 35356044230 SEROQUEL XR 400 MG TABLET 62750 QUETIAPINE FUMARATE QUALITY CARE 35356044800 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE QUALITY CARE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 158 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 35356044830 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE QUALITY CARE 35356045030 INVEGA ER 3 MG TABLET 61985 PALIPERIDONE QUALITY CARE 35356049130 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE QUALITY CARE 35356050230 INVEGA ER 6 MG TABLET 61986 PALIPERIDONE QUALITY CARE 35356050360 ALPRAZOLAM XR 1 MG TABLET 50400 ALPRAZOLAM QUALITY CARE 35356050460 ALPRAZOLAM XR 2 MG TABLET 50401 ALPRAZOLAM QUALITY CARE 35356050560 ALPRAZOLAM XR 3 MG TABLET 52143 ALPRAZOLAM QUALITY CARE 35356050630 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE QUALITY CARE 35356056730 PRISTIQ ER 100 MG TABLET 63737 DESVENLAFAXINE SUCCINATE QUALITY CARE 35356057930 VENLAFAXINE HCL ER 75 MG TAB 64445 VENLAFAXINE HCL QUALITY CARE 35356058030 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL QUALITY CARE 35356058930 NUVIGIL 150 MG TABLET 62819 ARMODAFINIL QUALITY CARE 35356059230 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL QUALITY CARE 35356061390 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM QUALITY CARE 35356061460 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM QUALITY CARE 35356061930 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE QUALITY CARE 35356062730 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL QUALITY CARE 35356064930 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL QUALITY CARE 35356065030 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL QUALITY CARE 35356065160 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL QUALITY CARE 37205009771 ST. JOHN'S WORT 375MG CAP 46334 ST. JOHN'S WORT LEADER 37205026471 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT LEADER 38245060414 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE COPLEY PHARMACEUTICAL, INC. 38245060415 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE COPLEY PHARMACEUTICAL, INC. 38245060814 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL COPLEY PHARMACEUTICAL, INC. 38245061214 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL COPLEY PHARMACEUTICAL, INC. 38245061314 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL COPLEY PHARMACEUTICAL, INC. 38245063014 FLUPHENAZINE 5MG/ML CONC 3822 FLUPHENAZINE HCL COPLEY PHARMACEUTICAL, INC. 38245063307 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM COPLEY PHARMACEUTICAL, INC. 38245068607 FLUPHENAZINE 2.5MG/5ML ELIX 3821 FLUPHENAZINE HCL COPLEY PHARMACEUTICAL, INC. 38245068612 FLUPHENAZINE 2.5MG/5ML ELIX 3821 FLUPHENAZINE HCL COPLEY PHARMACEUTICAL, INC. 38779168305 SODIUM VALPROATE POWDER 57977 VALPROATE SODIUM MEDISCA, INC. 38779224508 VALPROIC ACID LIQUID 51616 VALPROIC ACID MEDISCA, INC. 38779224509 VALPROIC ACID LIQUID 51616 VALPROIC ACID MEDISCA, INC. 39506003330 EMSAM 6 MG/24 HOURS PATCH 60453 SELEGILINE SOMERSET PHARMACEUTICALS INC 39506004430 EMSAM 9 MG/24 HOURS PATCH 60454 SELEGILINE SOMERSET PHARMACEUTICALS INC 39506005530 EMSAM 12 MG/24 HOURS PATCH 60455 SELEGILINE SOMERSET PHARMACEUTICALS INC 39769008802 HALOPERIDOL LAC 5MG/ML VIAL 3970 HALOPERIDOL LACTATE SOLOPAK PHARMACEUTICALS, INC. 39769012302 DROPERIDOL 2.5MG/ML VIAL 3965 DROPERIDOL SOLOPAK PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 159 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 41163042081 EQL ST JOHNS WORT 300 MG CPLT 46337 ST. JOHN'S WORT SOBA 41163045720 EQL ST. JOHN'S WORT 150 MG CAP 46331 ST. JOHN'S WORT SOBA 41616075881 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL SUN PHARMA GLOBAL, INC. 41616075883 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL SUN PHARMA GLOBAL, INC. 41616075981 VENLAFAXINE HCL ER 75 MG TAB 64445 VENLAFAXINE HCL SUN PHARMA GLOBAL, INC. 41616075983 VENLAFAXINE HCL ER 75 MG TAB 64445 VENLAFAXINE HCL SUN PHARMA GLOBAL, INC. 41616076081 VENLAFAXINE HCL ER 37.5 MG TAB 64444 VENLAFAXINE HCL SUN PHARMA GLOBAL, INC. 41616076083 VENLAFAXINE HCL ER 37.5 MG TAB 64444 VENLAFAXINE HCL SUN PHARMA GLOBAL, INC. 42254001430 NUVIGIL 50 MG TABLET 62820 ARMODAFINIL LABELER NOT ON FILE 42254003314 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 42254003330 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 42254003360 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 42254004830 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 42254004860 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 42254004890 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 42254005030 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL LABELER NOT ON FILE 42254005060 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL LABELER NOT ON FILE 42254006600 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 42254008630 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 42254008660 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 42254008690 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 42254008760 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 42254009690 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 42254010800 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 42254010890 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 42254011130 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 42254011190 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 42254011360 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 42254011560 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL LABELER NOT ON FILE 42254011660 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 42254011930 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 42254012600 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 42254014430 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 42291021090 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 42291021190 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 42291021290 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 42549030930 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 42549032930 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 42549033630 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 160 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 42549050930 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 42549052930 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 42549052960 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 42549052990 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 42549053630 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 42549054630 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 42549054660 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 42549055430 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 42549055460 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 42549055492 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 42549055830 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 42549059930 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 42549060320 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 42549060330 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 42549060360 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 42549060390 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 42549060530 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 42549060560 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 42549061330 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 42549064630 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 42549065510 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 42769122100 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE BAY PHARMA, INC. 42769122200 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE BAY PHARMA, INC. 42769122500 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE BAY PHARMA, INC. 42769133101 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE BAY PHARMA, INC. 42806001901 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE EPIC PHARMA LLC 42806001910 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE EPIC PHARMA LLC 42806002001 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE EPIC PHARMA LLC 42806002010 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE EPIC PHARMA LLC 42806002101 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE EPIC PHARMA LLC 42806002110 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE EPIC PHARMA LLC 43063000901 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 43063001806 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 43063003003 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 43063003006 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 43063003010 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 43063003012 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 43063003301 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 43063004603 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 161 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43063004606 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43063004612 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43063004615 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43063004619 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43063004804 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43063004806 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43063004815 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43063005706 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 43063006106 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43063008806 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43063016412 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 43063018360 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL LABELER NOT ON FILE 43063018645 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43063018660 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43063018690 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43063019360 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 43063019660 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 43063019690 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 43063019730 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 43063020230 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE LABELER NOT ON FILE 43063020260 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE LABELER NOT ON FILE 43063020290 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE LABELER NOT ON FILE 43063020330 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 43063020390 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 43063022101 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43063022130 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43063022190 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43063023830 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE LABELER NOT ON FILE 43063024330 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 43063024930 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43063025430 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43063025460 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43063025530 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 43063025730 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL LABELER NOT ON FILE 43063025930 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE LABELER NOT ON FILE 43063025960 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE LABELER NOT ON FILE 43063026230 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE LABELER NOT ON FILE 43063028498 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 43063029230 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 162 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43063029530 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 43063033630 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 43063033660 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 43068010102 FANAPT 1 MG TABLET 65901 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43068010202 FANAPT 2 MG TABLET 65902 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43068010402 FANAPT 4 MG TABLET 65903 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43068010602 FANAPT 6 MG TABLET 65904 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43068010802 FANAPT 8 MG TABLET 65905 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43068011002 FANAPT 10 MG TABLET 65906 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43068011202 FANAPT 12 MG TABLET 65907 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43068011304 FANAPT TITRATION PACK 65908 ILOPERIDONE VANDA PHARMACEUTICALS, INC. 43072000503 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT LABELER NOT ON FILE 43353007430 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 43353007460 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 43353011660 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353014353 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353014360 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353014380 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353025415 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43353025430 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43353025453 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43353025460 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43353025470 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43353025480 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 43353025530 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353025553 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353025560 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353025570 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353025575 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353025580 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353025590 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353025592 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 43353030215 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 43353030245 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 43353035715 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353035730 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353035753 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353035760 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353035770 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 163 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43353035820 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035830 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035845 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035853 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035860 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035870 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035875 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035880 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035892 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353035930 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353035945 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353035953 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353035960 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353035970 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353035975 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353035980 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353035990 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353036215 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036230 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036245 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036253 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036260 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036273 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036280 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036415 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036430 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036445 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036460 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353036480 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353037053 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 43353037815 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 43353037845 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 43353037853 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 43353038230 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353038284 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353040115 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353040130 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353040140 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353040145 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 164 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43353040160 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353040330 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353040345 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353040360 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353040430 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353040453 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353040460 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353040480 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353041215 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353041230 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353041245 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353041260 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353041515 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041530 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041545 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041553 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041560 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041573 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041580 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041915 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041930 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041945 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041953 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041960 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041973 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353041980 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353042130 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353042170 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353042180 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353042184 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353042615 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353042630 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353042645 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353042653 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353042660 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353042670 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353042915 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 43353043230 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353043245 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 165 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43353043260 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353043530 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353044153 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 43353044715 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353044730 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353044745 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353044753 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 43353045015 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353045030 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353045045 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353045048 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353045060 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353046030 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353046045 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353046060 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353048115 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353048145 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353048173 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353049015 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 43353049030 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 43353049045 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 43353049053 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 43353049060 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 43353051515 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353051530 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353051545 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353051553 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353051560 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353051570 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353051715 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 43353051760 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 43353053515 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 43353053560 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 43353053615 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 43353053645 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 43353053653 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 43353053882 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL LABELER NOT ON FILE 43353054330 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353054345 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 166 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43353054360 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353054415 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 43353054630 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 43353054680 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 43353054753 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 43353054760 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 43353054770 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 43353054780 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 43353055415 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 43353055520 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353055530 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353055553 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353055555 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353055560 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353055570 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353055575 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353055592 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 43353056060 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353057215 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353057230 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353057253 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353057260 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353057270 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353057275 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 43353057315 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353057330 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353057345 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353057360 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353057453 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 43353057470 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 43353057480 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 43353057488 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 43353057494 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 43353057553 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353057570 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353057580 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353057592 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353059730 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353060315 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 167 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43353060615 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353060630 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353060653 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353060760 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 43353061053 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353061060 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353061070 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353061080 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353061092 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 43353061430 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE LABELER NOT ON FILE 43353062830 PAMELOR 25 MG CAPSULE 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 43353063730 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 43353063915 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 43353063930 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 43353064030 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 43353064060 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 43353064215 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353064245 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353064260 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 43353065215 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353065230 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353065245 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353065253 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353065260 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353065270 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 43353065330 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353065360 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353065380 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 43353068953 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 43353069030 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353069053 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353069060 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353069070 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353069080 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353069084 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 43353069830 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43353069853 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43353069860 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43353069930 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 168 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43353069953 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43353069960 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 43353070515 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353070530 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353070553 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353070560 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353070570 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 43353071315 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 43353072015 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 43353072030 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 43353073582 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL LABELER NOT ON FILE 43353075415 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353075430 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353075445 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353075460 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 43353075515 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353075530 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353075545 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353075560 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 43353075715 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 43353075730 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 43353075745 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 43353076630 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE LABELER NOT ON FILE 43353076753 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353076760 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353076770 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353076780 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43353076792 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 43386036021 PHENELZINE SULFATE 15 MG TAB 46263 PHENELZINE SULFATE GAVIS PHARMACEUTICALS, LLC 43547025110 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL SOLCO HEALTHCARE US, LLC 43547025210 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOLCO HEALTHCARE US, LLC 43547025310 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL SOLCO HEALTHCARE US, LLC 43567053807 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567053812 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567053907 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567053912 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567054007 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567054010 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567054012 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 169 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 43567054107 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567054207 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43567054307 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL CELLTECH PHARMACEUTICALS 43595008003 OLEPTRO ER 150 MG TABLET 66436 TRAZODONE HCL LABOPHARM PHARMACEUTICALS, LLC 43595008103 OLEPTRO ER 300 MG TABLET 66440 TRAZODONE HCL LABOPHARM PHARMACEUTICALS, LLC 43797001412 ZETRAN 5MG/ML VIAL 3763 DIAZEPAM SHIRE US INC. 43797002612 ORMAZINE 25MG/ML VIAL 3790 CHLORPROMAZINE HCL SHIRE US INC. 43797029003 MITRAN 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SHIRE US INC. 43797029503 MITRAN 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SHIRE US INC. 43797029505 MITRAN 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SHIRE US INC. 44514009818 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 44514009918 LORAZEPAM 1MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 44514010018 LORAZEPAM 2MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 44514049588 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL LABELER NOT ON FILE 44514095518 DIAZEPAM 5MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 45802030665 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 45802030678 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 45802059665 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 45802059678 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 45802061665 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 45802061678 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PERRIGO PHARMACEUTICALS 45963029330 TRIMIPRAMINE MALEATE 25 MG CAP 46112 TRIMIPRAMINE MALEATE ACTAVIS INC. 45963029430 TRIMIPRAMINE MALEATE 50 MG CAP 46113 TRIMIPRAMINE MALEATE ACTAVIS INC. 45963029530 TRIMIPRAMINE MALEATE 100 MG CP 46111 TRIMIPRAMINE MALEATE ACTAVIS INC. 45963034102 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL ACTAVIS INC. 45963034202 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL ACTAVIS INC. 45963034302 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL ACTAVIS INC. 45963034402 DESIPRAMINE 75 MG TABLET 46108 DESIPRAMINE HCL ACTAVIS INC. 45963034502 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL ACTAVIS INC. 45963034650 DESIPRAMINE 150 MG TABLET 46105 DESIPRAMINE HCL ACTAVIS INC. 47028001201 POXI 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SENECA PHARMACEUTICALS, INC 47335060313 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060318 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060388 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060413 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060418 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060488 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060513 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060518 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SUN PHARMA GLOBAL FZE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 170 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 47335060588 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335060688 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SUN PHARMA GLOBAL FZE 47335073613 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SUN PHARMA GLOBAL FZE 47335073686 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SUN PHARMA GLOBAL FZE 47335073688 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SUN PHARMA GLOBAL FZE 47335073713 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SUN PHARMA GLOBAL FZE 47335073786 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SUN PHARMA GLOBAL FZE 47335073788 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SUN PHARMA GLOBAL FZE 47335073886 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL SUN PHARMA GLOBAL FZE 47335090218 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090288 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090318 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090388 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090418 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090488 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090518 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090588 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090618 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090686 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090688 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090718 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47335090788 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE SUN PHARMA GLOBAL FZE 47463302590 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL LABELER NOT ON FILE 47463340230 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 47463340260 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 47463443190 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE LABELER NOT ON FILE 47463444115 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 47463600330 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 48107004345 ST. JOHN'S WRT 1,000 MG SFTGL 47848 ST. JOHN'S WORT LABELER NOT ON FILE 48107005025 ST. JOHN'S WORT 300 MG TAB 46337 ST. JOHN'S WORT LABELER NOT ON FILE 48107005136 ST. JOHN'S WORT 300 MG TAB 46337 ST. JOHN'S WORT LABELER NOT ON FILE 49348016809 SM ST. JOHN'S WORT CAPLET 46337 ST. JOHN'S WORT MCKESSON CORPORATION VALU-RITE 49502090030 EMSAM 6 MG/24 HOURS PATCH 60453 SELEGILINE DEY L.P. 49502090130 EMSAM 9 MG/24 HOURS PATCH 60454 SELEGILINE DEY L.P. 49502090230 EMSAM 12 MG/24 HOURS PATCH 60455 SELEGILINE DEY L.P. 49614016371 ST. JOHN S WORT 300 MG CPLT 46337 ST. JOHN'S WORT MEDICINE SHOPPE INTERNATIONAL, INC. 49727015902 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727015905 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727016202 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 171 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49727016205 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727016302 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727016305 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727016402 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727016502 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727016602 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL LABELER NOT ON FILE 49727029305 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE LABELER NOT ON FILE 49727049002 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL LABELER NOT ON FILE 49727049005 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL LABELER NOT ON FILE 49727049102 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 49727049105 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 49727049202 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 49727049205 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 49727060002 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060004 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060102 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060104 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060202 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060204 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060302 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060304 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727060402 AMITRIP/PERPHEN 50-4 TABLET 46188 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49727078102 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL LABELER NOT ON FILE 49727078202 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL LABELER NOT ON FILE 49848001000 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49848001100 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49848001200 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 49848001300 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 49848001400 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 49848001530 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 49848001630 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE LABELER NOT ON FILE 49848001730 ZYPREXA ZYDIS 10 MG TABLET 45191 OLANZAPINE LABELER NOT ON FILE 49848001830 ZYPREXA ZYDIS 5 MG TABLET 45190 OLANZAPINE LABELER NOT ON FILE 49848001930 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 49848002030 ABILIFY 20 MG TABLET 51335 ARIPIPRAZOLE LABELER NOT ON FILE 49848002130 ABILIFY 30 MG TABLET 51336 ARIPIPRAZOLE LABELER NOT ON FILE 49848002230 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 49848002330 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 49848002460 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 172 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49848002500 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49848002600 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE LABELER NOT ON FILE 49848002730 ZYPREXA ZYDIS 20 MG TABLET 47286 OLANZAPINE LABELER NOT ON FILE 49848002830 ZYPREXA 10 MG TABLET 27960 OLANZAPINE LABELER NOT ON FILE 49848002930 ZYPREXA 20 MG TABLET 41027 OLANZAPINE LABELER NOT ON FILE 49848003000 SEROQUEL 400 MG TABLET 60293 QUETIAPINE FUMARATE LABELER NOT ON FILE 49848003130 ZYPREXA 15 MG TABLET 41026 OLANZAPINE LABELER NOT ON FILE 49884003201 TRANYLCYPROMINE SULF 10 MG TAB 46264 TRANYLCYPROMINE SULFATE PAR PHARMACEUTICAL, INC 49884005401 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL PAR PHARMACEUTICAL, INC 49884005410 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL PAR PHARMACEUTICAL, INC 49884005501 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL PAR PHARMACEUTICAL, INC 49884005510 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL PAR PHARMACEUTICAL, INC 49884005601 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL PAR PHARMACEUTICAL, INC 49884005610 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL PAR PHARMACEUTICAL, INC 49884006101 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884006105 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884006201 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884006205 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884006401 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884006405 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884007601 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884007605 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL PAR PHARMACEUTICAL, INC 49884008801 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE PAR PHARMACEUTICAL, INC 49884008901 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE PAR PHARMACEUTICAL, INC 49884008905 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE PAR PHARMACEUTICAL, INC 49884011052 ALPRAZOLAM ODT 0.25 MG TAB 58847 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884011074 ALPRAZOLAM ODT 0.25 MG TAB 58847 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884011152 ALPRAZOLAM ODT 0.5 MG TAB 58848 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884011174 ALPRAZOLAM ODT 0.5 MG TAB 58848 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884021252 RISPERIDONE 0.25 MG ODT 65235 RISPERIDONE PAR PHARMACEUTICAL, INC 49884021255 RISPERIDONE 0.25 MG ODT 65235 RISPERIDONE PAR PHARMACEUTICAL, INC 49884021352 ALPRAZOLAM ODT 1 MG TAB 58849 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884021374 ALPRAZOLAM ODT 1 MG TAB 58849 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884021452 ALPRAZOLAM ODT 2 MG TAB 58850 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884021474 ALPRAZOLAM ODT 2 MG TAB 58850 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884021701 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884021705 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884021710 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884021801 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PAR PHARMACEUTICAL, INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 173 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49884021805 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884021810 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884021901 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884021905 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884021910 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022001 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022005 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022010 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022101 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022105 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022110 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022201 DOXEPIN 150 MG CAPSULE 46088 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022203 DOXEPIN 150 MG CAPSULE 46088 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022205 DOXEPIN 150 MG CAPSULE 46088 DOXEPIN HCL PAR PHARMACEUTICAL, INC 49884022301 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022305 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022310 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022401 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022405 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022410 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022501 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022505 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022510 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022601 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022605 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022610 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022701 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884022705 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL PAR PHARMACEUTICAL, INC 49884031152 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE PAR PHARMACEUTICAL, INC 49884031155 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE PAR PHARMACEUTICAL, INC 49884031191 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE PAR PHARMACEUTICAL, INC 49884031552 RISPERIDONE 1 MG ODT 51799 RISPERIDONE PAR PHARMACEUTICAL, INC 49884031555 RISPERIDONE 1 MG ODT 51799 RISPERIDONE PAR PHARMACEUTICAL, INC 49884031591 RISPERIDONE 1 MG ODT 51799 RISPERIDONE PAR PHARMACEUTICAL, INC 49884032052 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE PAR PHARMACEUTICAL, INC 49884032055 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE PAR PHARMACEUTICAL, INC 49884032152 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE PAR PHARMACEUTICAL, INC 49884032155 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE PAR PHARMACEUTICAL, INC 49884032252 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE PAR PHARMACEUTICAL, INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 174 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49884032255 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE PAR PHARMACEUTICAL, INC 49884032352 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE PAR PHARMACEUTICAL, INC 49884032355 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE PAR PHARMACEUTICAL, INC 49884040001 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884040005 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884040152 RISPERIDONE 2 MG ODT 51800 RISPERIDONE PAR PHARMACEUTICAL, INC 49884040191 RISPERIDONE 2 MG ODT 51800 RISPERIDONE PAR PHARMACEUTICAL, INC 49884040252 RISPERIDONE 3 MG ODT 59402 RISPERIDONE PAR PHARMACEUTICAL, INC 49884040291 RISPERIDONE 3 MG ODT 59402 RISPERIDONE PAR PHARMACEUTICAL, INC 49884040352 RISPERIDONE 4 MG ODT 59403 RISPERIDONE PAR PHARMACEUTICAL, INC 49884040391 RISPERIDONE 4 MG ODT 59403 RISPERIDONE PAR PHARMACEUTICAL, INC 49884044801 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884044805 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884044901 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884044905 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884045001 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884045005 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM PAR PHARMACEUTICAL, INC 49884053411 MODAFINIL 100 MG TABLET 25848 MODAFINIL PAR PHARMACEUTICAL, INC 49884053511 MODAFINIL 200 MG TABLET 41478 MODAFINIL PAR PHARMACEUTICAL, INC 49884065501 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PAR PHARMACEUTICAL, INC 49884065511 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PAR PHARMACEUTICAL, INC 49884065601 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PAR PHARMACEUTICAL, INC 49884065611 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PAR PHARMACEUTICAL, INC 49884069937 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884070701 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884070705 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884070801 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884070805 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072001 VANSPAR 7.5 MG TABLET 47644 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072005 VANSPAR 7.5 MG TABLET 47644 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072101 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072102 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072105 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072113 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072501 BUSPIRONE HCL 7.5 MG TABLET 47644 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884072505 BUSPIRONE HCL 7.5 MG TABLET 47644 BUSPIRONE HCL PAR PHARMACEUTICAL, INC 49884073201 FLUOXETINE 10 MG CAPSULE 46213 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073210 FLUOXETINE 10 MG CAPSULE 46213 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073301 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL PAR PHARMACEUTICAL, INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 175 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49884073310 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073382 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073401 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073410 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073411 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073482 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073501 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073510 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073511 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884073582 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884074301 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884074305 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884074311 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884075101 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884075110 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884075901 RAPIFLUX 20 MG TABLET 46219 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884087201 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884087205 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884087211 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PAR PHARMACEUTICAL, INC 49884087301 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PAR PHARMACEUTICAL, INC 49884087311 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PAR PHARMACEUTICAL, INC 49884087605 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087611 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087701 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087705 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087711 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087805 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087811 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087905 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884087911 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PAR PHARMACEUTICAL, INC 49884091602 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884091605 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884091702 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884091705 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884091802 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884091805 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884091902 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884091905 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884092002 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL PAR PHARMACEUTICAL, INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 176 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49884092005 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL PAR PHARMACEUTICAL, INC 49884095801 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL PAR PHARMACEUTICAL, INC 49884095901 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PAR PHARMACEUTICAL, INC 49884096001 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PAR PHARMACEUTICAL, INC 49884096101 AMITRIP-CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEPAR PHARMACEUTICAL, INC 49884096201 AMITRIP-CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEPAR PHARMACEUTICAL, INC 49909000530 FLUOXETINE HCL 60 MG TABLET 68117 FLUOXETINE HCL EDGEMONT PHARMACEUTICALS, LLC 49999001802 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001805 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001810 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001815 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001820 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001821 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001830 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001860 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999001890 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 49999002700 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 49999002701 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 49999002702 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 49999002720 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 49999002730 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 49999002760 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 49999002790 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 49999003200 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 49999003202 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 49999003204 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 49999003215 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 49999003230 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 49999003260 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 49999003290 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 49999003910 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 49999003915 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 49999003930 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 49999003960 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 49999003990 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 49999006300 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999006315 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999006330 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999006350 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 177 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49999006360 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999006390 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999012201 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 49999012214 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 49999012220 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 49999012230 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 49999012260 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 49999012290 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 49999012800 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 49999012814 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 49999012820 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 49999012830 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 49999012860 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 49999012890 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 49999015600 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 49999015614 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 49999015620 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 49999015630 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 49999015660 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 49999019030 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 49999020500 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999020530 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999020560 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999021450 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 49999021525 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999021530 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999021560 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999021590 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999022800 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999022830 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999022860 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999022890 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999024410 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 49999024420 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 49999024430 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 49999024915 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 49999024930 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 49999025200 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 49999025202 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 178 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49999025204 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 49999025210 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 49999025230 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 49999025260 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 49999025290 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 49999025300 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 49999025360 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 49999025390 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 49999026630 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 49999029215 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 49999029230 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 49999031800 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999031830 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999031860 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999032230 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID LABELER NOT ON FILE 49999034300 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 49999034315 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 49999034330 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 49999034360 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 49999034900 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 49999034930 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 49999034960 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 49999034990 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 49999036214 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL LABELER NOT ON FILE 49999036230 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL LABELER NOT ON FILE 49999036290 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL LABELER NOT ON FILE 49999037500 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 49999037515 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 49999037530 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 49999038130 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 49999040030 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 49999044315 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 49999044330 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 49999053830 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999053860 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999055130 PERPHEN-AMITRIP 2 MG-25 MG TAB 46186 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 49999059530 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 49999059630 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 49999059730 PAXIL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 179 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49999059815 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE LABELER NOT ON FILE 49999059830 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE LABELER NOT ON FILE 49999059915 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 49999059930 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 49999059960 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 49999059990 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 49999060000 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49999060015 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49999060030 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49999060090 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49999060115 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL LABELER NOT ON FILE 49999060130 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL LABELER NOT ON FILE 49999060200 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 49999060215 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 49999060230 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 49999060300 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 49999060315 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 49999060330 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 49999060615 ZYPREXA 10 MG TABLET 27960 OLANZAPINE LABELER NOT ON FILE 49999060630 ZYPREXA 10 MG TABLET 27960 OLANZAPINE LABELER NOT ON FILE 49999061330 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 49999061730 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL LABELER NOT ON FILE 49999061830 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 49999061860 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 49999061930 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 49999061960 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 49999062010 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL LABELER NOT ON FILE 49999062060 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL LABELER NOT ON FILE 49999062160 GEODON 60 MG CAPSULE 47567 ZIPRASIDONE HCL LABELER NOT ON FILE 49999062700 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49999062730 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49999062760 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 49999062930 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 49999062960 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 49999063030 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 49999063130 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 49999063160 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 49999063200 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 49999063230 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 180 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49999063260 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 49999063315 RISPERDAL 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 49999063430 RISPERDAL 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 49999063460 RISPERDAL 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 49999063630 STRATTERA 25 MG CAPSULE 51491 ATOMOXETINE HCL LABELER NOT ON FILE 49999063690 STRATTERA 25 MG CAPSULE 51491 ATOMOXETINE HCL LABELER NOT ON FILE 49999063730 STRATTERA 60 MG CAPSULE 51493 ATOMOXETINE HCL LABELER NOT ON FILE 49999065400 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 49999065430 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 49999067400 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 49999069030 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 49999069615 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 49999073601 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 49999073915 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 49999073930 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 49999077430 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 49999077460 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 49999077490 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 49999077560 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE LABELER NOT ON FILE 49999077630 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 49999077650 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 49999078030 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL LABELER NOT ON FILE 49999078930 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 49999078960 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 49999078990 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 49999080530 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 49999081200 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 49999081230 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 49999081260 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 49999081630 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 49999081690 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 49999081730 ABILIFY 15 MG TABLET 51334 ARIPIPRAZOLE LABELER NOT ON FILE 49999081830 ABILIFY 20 MG TABLET 51335 ARIPIPRAZOLE LABELER NOT ON FILE 49999082830 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 49999086030 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 49999086060 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 49999086090 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 49999086130 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 49999086160 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 181 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 49999086190 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 49999087400 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 49999087460 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 49999087500 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 49999087560 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 49999088630 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 49999090900 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999090930 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999090960 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 49999091115 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE LABELER NOT ON FILE 49999091330 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 49999091530 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999091560 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999091590 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 49999091830 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 49999094100 DEPAKOTE 250 MG TABLET EC 4539 DIVALPROEX SODIUM LABELER NOT ON FILE 49999094130 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM LABELER NOT ON FILE 49999094230 DEPAKOTE 125 MG SPRINKLE CAP 4537 DIVALPROEX SODIUM LABELER NOT ON FILE 49999095130 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 49999096530 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 49999096560 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 50111036601 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL PLIVA, INC. 50111036603 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PLIVA, INC. 50111036701 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL PLIVA, INC. 50111036703 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL PLIVA, INC. 50111036801 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PLIVA, INC. 50111036803 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PLIVA, INC. 50111036901 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL PLIVA, INC. 50111036903 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL PLIVA, INC. 50111037001 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PLIVA, INC. 50111037101 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL PLIVA, INC. 50111043301 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PLIVA, INC. 50111043302 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PLIVA, INC. 50111043303 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PLIVA, INC. 50111043401 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PLIVA, INC. 50111043402 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PLIVA, INC. 50111043403 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PLIVA, INC. 50111043601 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL PLIVA, INC. 50111043603 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL PLIVA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 182 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 50111043701 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL PLIVA, INC. 50111043703 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL PLIVA, INC. 50111043801 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL PLIVA, INC. 50111043803 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL PLIVA, INC. 50111043901 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL PLIVA, INC. 50111044005 DESIPRAMINE 150MG TABLET 46105 DESIPRAMINE HCL PLIVA, INC. 50111044101 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PLIVA, INC. 50111044102 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PLIVA, INC. 50111052301 PROTRIPTYLINE 5MG TABLET 46080 PROTRIPTYLINE HCL PLIVA, INC. 50111052401 PROTRIPTYLINE 10MG TABLET 46079 PROTRIPTYLINE HCL PLIVA, INC. 50111064701 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PLIVA, INC. 50111064702 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PLIVA, INC. 50111064703 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PLIVA, INC. 50111064801 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PLIVA, INC. 50111064802 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PLIVA, INC. 50111064803 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PLIVA, INC. 50111064810 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL PLIVA, INC. 50111064844 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PLIVA, INC. 50111085201 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PLIVA, INC. 50111093010 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PLIVA, INC. 50111093101 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PLIVA, INC. 50111093102 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PLIVA, INC. 50111093110 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PLIVA, INC. 50111093201 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PLIVA, INC. 50111093202 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PLIVA, INC. 50111093210 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PLIVA, INC. 50111098601 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PLIVA, INC. 50111098602 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PLIVA, INC. 50111098701 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PLIVA, INC. 50111098702 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PLIVA, INC. 50111098801 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM PLIVA, INC. 50383003804 THIORIDAZINE 100 MG/ML CONC 3857 THIORIDAZINE HCL HI-TECH PHARMACAL CO. INC. 50383003904 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL HI-TECH PHARMACAL CO. INC. 50383079216 VALPROIC ACID 250 MG/5 ML SOLN 4535 VALPROATE SODIUM HI-TECH PHARMACAL CO. INC. 50428972158 CVS ST.JOHN WORT 300MG CPLT 46337 ST. JOHN'S WORT LABELER NOT ON FILE 50428974626 CVS ST JOHN'S WORT 300 MG CAP 46333 ST. JOHN'S WORT LABELER NOT ON FILE 50428974642 CVS ST JOHN'S WORT 300 MG CAP 46333 ST. JOHN'S WORT LABELER NOT ON FILE 50458001001 INAPSINE 2.5MG/ML AMPUL 3964 DROPERIDOL ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458001002 INAPSINE 2.5MG/ML AMPUL 3964 DROPERIDOL ORTHO-MCNEIL JANSSEN PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 183 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 50458001010 INAPSINE 2.5MG/ML AMPUL 3964 DROPERIDOL ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458025303 HALDOL DECANOATE 50 AMPUL 3966 HALOPERIDOL DECANOATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458025414 HALDOL DECANOATE 100 AMPUL 13076 HALOPERIDOL DECANOATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458025501 HALDOL 5 MG/ML AMPUL 3968 HALOPERIDOL LACTATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030001 RISPERDAL 1 MG TABLET 21154 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030006 RISPERDAL 1 MG TABLET 21154 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030050 RISPERDAL 1 MG TABLET 21154 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030101 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030104 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030150 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030201 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030206 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030250 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030503 RISPERDAL 1 MG/ML SOLUTION 26177 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030510 RISPERDAL 1MG/ML SOLUTION 26177 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030611 RISPERDAL CONSTA 25 MG SYR 52934 RISPERIDONE MICROSPHERES ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030711 RISPERDAL CONSTA 37.5 MG SYR 52935 RISPERIDONE MICROSPHERES ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030811 RISPERDAL CONSTA 50 MG SYR 52936 RISPERIDONE MICROSPHERES ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458030911 RISPERDAL CONSTA 12.5 MG SYR 62640 RISPERIDONE MICROSPHERES ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458031528 RISPERDAL M-TAB 1 MG ODT 51799 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458031530 RISPERDAL M-TAB 1 MG ODT 51799 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458032001 RISPERDAL 2 MG TABLET 21155 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458032006 RISPERDAL 2 MG TABLET 21155 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458032050 RISPERDAL 2 MG TABLET 21155 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458032528 RISPERDAL M-TAB 2 MG ODT 51800 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458033001 RISPERDAL 3 MG TABLET 21156 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458033006 RISPERDAL 3 MG TABLET 21156 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458033050 RISPERDAL 3 MG TABLET 21156 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458033528 RISPERDAL M-TAB 3 MG ODT 59402 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458035001 RISPERDAL 4 MG TABLET 21157 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458035006 RISPERDAL 4 MG TABLET 21157 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458035528 RISPERDAL M-TAB 4 MG ODT 59403 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458039528 RISPERDAL M-TAB 0.5 MG ODT 52049 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458039530 RISPERDAL M-TAB 0.5 MG ODT 52049 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055001 INVEGA ER 3 MG TABLET 61985 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055002 INVEGA ER 3 MG TABLET 61985 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055010 INVEGA ER 3 MG TABLET 61985 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055101 INVEGA ER 6 MG TABLET 61986 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055102 INVEGA ER 6 MG TABLET 61986 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 184 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 50458055110 INVEGA ER 6 MG TABLET 61986 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055201 INVEGA ER 9 MG TABLET 61987 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055202 INVEGA ER 9 MG TABLET 61987 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055210 INVEGA ER 9 MG TABLET 61987 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458055401 INVEGA ER 1.5 MG TABLET 65667 PALIPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458056001 INVEGA SUSTENNA 39 MG PREF SYR 65448 PALIPERIDONE PALMITATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458056101 INVEGA SUSTENNA 78 MG PREF SYR 65449 PALIPERIDONE PALMITATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458056201 INVEGA SUSTENNA 117 MG PREF SY 65450 PALIPERIDONE PALMITATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458056301 INVEGA SUSTENNA 156 MG PREF SY 65451 PALIPERIDONE PALMITATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458056401 INVEGA SUSTENNA 234 MG PREF SY 65452 PALIPERIDONE PALMITATE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059010 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059050 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059060 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059110 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059150 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059160 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059210 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059250 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059260 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059310 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059350 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059360 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059410 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059450 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059460 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059510 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059560 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458059601 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458060128 RISPERIDONE M-TAB 0.5 MG ODT 52049 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458060228 RISPERIDONE M-TAB 1 MG ODT 51799 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458060328 RISPERIDONE M-TAB 2 MG ODT 51800 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458060428 RISPERIDONE M-TAB 3 MG ODT 59402 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50458060528 RISPERIDONE M-TAB 4 MG ODT 59403 RISPERIDONE ORTHO-MCNEIL JANSSEN PHARMACEUTICALS 50550039170 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL LABELER NOT ON FILE 50752025005 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025006 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025008 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025105 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025106 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 185 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 50752025108 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025205 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025206 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025208 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025305 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025306 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752025308 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL CREIGHTON PRODUCTS CORPORATION 50752026405 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026406 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026409 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026505 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026605 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026606 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026609 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026705 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026706 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026709 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026805 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026806 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026809 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752026905 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752027005 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752027006 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL CREIGHTON PRODUCTS CORPORATION 50752029408 LORAZEPAM 1MG TABLET 3758 LORAZEPAM CREIGHTON PRODUCTS CORPORATION 50752029409 LORAZEPAM 1MG TABLET 3758 LORAZEPAM CREIGHTON PRODUCTS CORPORATION 50752029605 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE CREIGHTON PRODUCTS CORPORATION 50752029705 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE CREIGHTON PRODUCTS CORPORATION 50752029805 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE CREIGHTON PRODUCTS CORPORATION 50752029905 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE CREIGHTON PRODUCTS CORPORATION 50962022605 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM ACTAVIS 50962022660 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM ACTAVIS 50962022661 VALPROIC ACID 250MG/5ML SYR 4535 VALPROATE SODIUM ACTAVIS 50962023157 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID ACTAVIS 50962032505 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE ACTAVIS 50962032510 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE ACTAVIS 50962032603 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE ACTAVIS 50962037604 THIORIDAZINE 30MG/ML CONC 3858 THIORIDAZINE HCL ACTAVIS 50962037702 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL ACTAVIS 50962037704 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL ACTAVIS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 186 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 50962037901 FLUPHENAZINE 5MG/ML CONC 3822 FLUPHENAZINE HCL ACTAVIS 50962050005 PROZAC 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL ACTAVIS 50962050060 PROZAC 20MG/5ML SOLUTION 46217 FLUOXETINE HCL ACTAVIS 50962052505 LITHIUM CIT 8MEQ/5ML SYRUP 4006 LITHIUM CITRATE ACTAVIS 50962052510 LITHIUM CIT 8MEQ/5ML SYRUP 4006 LITHIUM CITRATE ACTAVIS 51079004701 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL UDL LABORATORIES, INC. 51079004720 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL UDL LABORATORIES, INC. 51079008601 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE UDL LABORATORIES, INC. 51079008620 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE UDL LABORATORIES, INC. 51079008656 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE UDL LABORATORIES, INC. 51079008701 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE UDL LABORATORIES, INC. 51079008720 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE UDL LABORATORIES, INC. 51079008756 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE UDL LABORATORIES, INC. 51079008801 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE UDL LABORATORIES, INC. 51079008820 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE UDL LABORATORIES, INC. 51079008830 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE UDL LABORATORIES, INC. 51079008856 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE UDL LABORATORIES, INC. 51079010701 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079010717 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079010719 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079010720 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079010763 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079010901 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL UDL LABORATORIES, INC. 51079010903 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL UDL LABORATORIES, INC. 51079013001 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079013020 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079013101 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013117 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013119 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013120 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013163 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013301 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013317 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013319 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013320 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013363 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079013401 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079013420 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079013501 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 187 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079013520 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079013601 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079013604 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079014101 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079014120 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079014121 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079014701 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079014720 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079025301 LITHIUM CARBONAT 300 MG ER TAB 4004 LITHIUM CARBONATE UDL LABORATORIES, INC. 51079025320 LITHIUM CARBONAT 300 MG ER TAB 4004 LITHIUM CARBONATE UDL LABORATORIES, INC. 51079026901 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE UDL LABORATORIES, INC. 51079026920 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE UDL LABORATORIES, INC. 51079028401 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM UDL LABORATORIES, INC. 51079028420 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM UDL LABORATORIES, INC. 51079028421 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM UDL LABORATORIES, INC. 51079028501 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM UDL LABORATORIES, INC. 51079028520 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM UDL LABORATORIES, INC. 51079028521 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM UDL LABORATORIES, INC. 51079028598 DIAZEPAM 5MG TABLET 3768 DIAZEPAM UDL LABORATORIES, INC. 51079028601 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM UDL LABORATORIES, INC. 51079028620 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM UDL LABORATORIES, INC. 51079028621 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM UDL LABORATORIES, INC. 51079029801 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID UDL LABORATORIES, INC. 51079029808 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID UDL LABORATORIES, INC. 51079029820 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID UDL LABORATORIES, INC. 51079029856 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID UDL LABORATORIES, INC. 51079034501 RISPERIDONE 1 MG ODT 51799 RISPERIDONE UDL LABORATORIES, INC. 51079034505 RISPERIDONE 1 MG ODT 51799 RISPERIDONE UDL LABORATORIES, INC. 51079034601 RISPERIDONE 2 MG ODT 51800 RISPERIDONE UDL LABORATORIES, INC. 51079034605 RISPERIDONE 2 MG ODT 51800 RISPERIDONE UDL LABORATORIES, INC. 51079034701 RISPERIDONE 3 MG ODT 59402 RISPERIDONE UDL LABORATORIES, INC. 51079034705 RISPERIDONE 3 MG ODT 59402 RISPERIDONE UDL LABORATORIES, INC. 51079037401 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079037420 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079037421 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079037501 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079037520 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079037521 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL UDL LABORATORIES, INC. 51079038601 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 188 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079038617 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038619 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038620 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038621 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038623 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038624 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038656 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038699 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM UDL LABORATORIES, INC. 51079038701 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM UDL LABORATORIES, INC. 51079038720 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM UDL LABORATORIES, INC. 51079038721 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM UDL LABORATORIES, INC. 51079038756 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM UDL LABORATORIES, INC. 51079039101 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL UDL LABORATORIES, INC. 51079039120 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL UDL LABORATORIES, INC. 51079039201 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL UDL LABORATORIES, INC. 51079039220 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL UDL LABORATORIES, INC. 51079041701 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041717 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041719 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041720 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041721 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041723 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041724 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041756 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079041799 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM UDL LABORATORIES, INC. 51079042701 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL UDL LABORATORIES, INC. 51079042717 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL UDL LABORATORIES, INC. 51079042719 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL UDL LABORATORIES, INC. 51079042720 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL UDL LABORATORIES, INC. 51079042801 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL UDL LABORATORIES, INC. 51079042817 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL UDL LABORATORIES, INC. 51079042819 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL UDL LABORATORIES, INC. 51079042820 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL UDL LABORATORIES, INC. 51079043101 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL UDL LABORATORIES, INC. 51079043120 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL UDL LABORATORIES, INC. 51079043601 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL UDL LABORATORIES, INC. 51079043620 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL UDL LABORATORIES, INC. 51079043701 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL UDL LABORATORIES, INC. 51079043719 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 189 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079043720 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL UDL LABORATORIES, INC. 51079043801 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL UDL LABORATORIES, INC. 51079043819 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL UDL LABORATORIES, INC. 51079043820 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL UDL LABORATORIES, INC. 51079046001 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE UDL LABORATORIES, INC. 51079046020 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE UDL LABORATORIES, INC. 51079046101 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE UDL LABORATORIES, INC. 51079046120 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE UDL LABORATORIES, INC. 51079046201 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE UDL LABORATORIES, INC. 51079046220 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE UDL LABORATORIES, INC. 51079046230 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE UDL LABORATORIES, INC. 51079046256 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE UDL LABORATORIES, INC. 51079046301 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE UDL LABORATORIES, INC. 51079046320 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE UDL LABORATORIES, INC. 51079046330 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE UDL LABORATORIES, INC. 51079046356 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE UDL LABORATORIES, INC. 51079046401 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE UDL LABORATORIES, INC. 51079046420 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE UDL LABORATORIES, INC. 51079046430 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE UDL LABORATORIES, INC. 51079046456 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE UDL LABORATORIES, INC. 51079046501 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE UDL LABORATORIES, INC. 51079046520 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE UDL LABORATORIES, INC. 51079046530 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE UDL LABORATORIES, INC. 51079046556 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE UDL LABORATORIES, INC. 51079047401 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079047420 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079047501 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079047508 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079047520 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079047801 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM UDL LABORATORIES, INC. 51079047820 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM UDL LABORATORIES, INC. 51079047821 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM UDL LABORATORIES, INC. 51079047901 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM UDL LABORATORIES, INC. 51079047920 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM UDL LABORATORIES, INC. 51079047921 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM UDL LABORATORIES, INC. 51079048001 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079048020 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079048201 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079048220 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 190 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079048230 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079048256 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL UDL LABORATORIES, INC. 51079048501 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048520 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048601 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048620 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048701 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048717 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048719 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048720 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048801 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048820 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL UDL LABORATORIES, INC. 51079048920 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL UDL LABORATORIES, INC. 51079049020 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL UDL LABORATORIES, INC. 51079049120 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL UDL LABORATORIES, INC. 51079049801 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE UDL LABORATORIES, INC. 51079049820 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE UDL LABORATORIES, INC. 51079049901 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE UDL LABORATORIES, INC. 51079049920 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE UDL LABORATORIES, INC. 51079051601 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051620 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051701 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051720 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051801 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051820 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051901 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051919 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079051920 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL UDL LABORATORIES, INC. 51079054301 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079054320 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079054330 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079054356 ESCITALOPRAM 10 MG TABLET 50712 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079054401 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079054420 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079054430 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079054456 ESCITALOPRAM 20 MG TABLET 50760 ESCITALOPRAM OXALATE UDL LABORATORIES, INC. 51079056301 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079056320 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079056401 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 191 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079056420 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL UDL LABORATORIES, INC. 51079056501 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079056517 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079056519 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079056520 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079056601 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079056620 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079056701 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079056720 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079057201 TRIFLUOPERAZINE 1 MG TABLET 3851 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079057220 TRIFLUOPERAZINE 1 MG TABLET 3851 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079057301 TRIFLUOPERAZINE 2 MG TABLET 3853 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079057320 TRIFLUOPERAZINE 2 MG TABLET 3853 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079057401 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079057420 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079057501 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079057520 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL UDL LABORATORIES, INC. 51079058001 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079058020 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL UDL LABORATORIES, INC. 51079058601 THIOTHIXENE 1 MG CAPSULE 3995 THIOTHIXENE UDL LABORATORIES, INC. 51079058620 THIOTHIXENE 1 MG CAPSULE 3995 THIOTHIXENE UDL LABORATORIES, INC. 51079058701 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE UDL LABORATORIES, INC. 51079058720 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE UDL LABORATORIES, INC. 51079058801 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE UDL LABORATORIES, INC. 51079058820 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE UDL LABORATORIES, INC. 51079058901 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE UDL LABORATORIES, INC. 51079058920 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE UDL LABORATORIES, INC. 51079063320 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM UDL LABORATORIES, INC. 51079063420 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM UDL LABORATORIES, INC. 51079063520 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM UDL LABORATORIES, INC. 51079064501 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL UDL LABORATORIES, INC. 51079064520 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL UDL LABORATORIES, INC. 51079065101 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL UDL LABORATORIES, INC. 51079065120 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL UDL LABORATORIES, INC. 51079067720 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079067820 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079067920 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079068020 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079068737 THIOTHIXENE 5MG/ML ORAL CON 3994 THIOTHIXENE HCL UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 192 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079068837 DOXEPIN 10MG/ML ORAL CONC 46092 DOXEPIN HCL UDL LABORATORIES, INC. 51079073301 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL UDL LABORATORIES, INC. 51079073320 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL UDL LABORATORIES, INC. 51079073401 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL UDL LABORATORIES, INC. 51079073420 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL UDL LABORATORIES, INC. 51079073501 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL UDL LABORATORIES, INC. 51079073520 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL UDL LABORATORIES, INC. 51079073601 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL UDL LABORATORIES, INC. 51079073620 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL UDL LABORATORIES, INC. 51079073630 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL UDL LABORATORIES, INC. 51079073656 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL UDL LABORATORIES, INC. 51079073820 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE UDL LABORATORIES, INC. 51079073920 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE UDL LABORATORIES, INC. 51079074020 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE UDL LABORATORIES, INC. 51079074901 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE UDL LABORATORIES, INC. 51079074920 CLOZAPINE 200 MG TABLET 46416 CLOZAPINE UDL LABORATORIES, INC. 51079076201 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL UDL LABORATORIES, INC. 51079076220 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL UDL LABORATORIES, INC. 51079076301 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL UDL LABORATORIES, INC. 51079076320 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL UDL LABORATORIES, INC. 51079076401 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL UDL LABORATORIES, INC. 51079076420 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL UDL LABORATORIES, INC. 51079076501 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076508 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076530 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076556 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076601 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076608 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076701 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076708 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076730 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079076756 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM UDL LABORATORIES, INC. 51079077401 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL UDL LABORATORIES, INC. 51079077420 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL UDL LABORATORIES, INC. 51079077520 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL UDL LABORATORIES, INC. 51079078801 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM UDL LABORATORIES, INC. 51079078817 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM UDL LABORATORIES, INC. 51079078819 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM UDL LABORATORIES, INC. 51079078820 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 193 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079078821 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM UDL LABORATORIES, INC. 51079078901 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM UDL LABORATORIES, INC. 51079078920 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM UDL LABORATORIES, INC. 51079078921 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM UDL LABORATORIES, INC. 51079079001 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM UDL LABORATORIES, INC. 51079079020 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM UDL LABORATORIES, INC. 51079079021 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM UDL LABORATORIES, INC. 51079079710 HALOPERIDOL 1MG/ML SOLUTION 26096 HALOPERIDOL LACTATE UDL LABORATORIES, INC. 51079079810 HALOPERIDOL 1MG/ML SOLUTION 26096 HALOPERIDOL LACTATE UDL LABORATORIES, INC. 51079079910 HALOPERIDOL 1MG/ML SOLUTION 26096 HALOPERIDOL LACTATE UDL LABORATORIES, INC. 51079080010 HALOPERIDOL 1MG/ML SOLUTION 26096 HALOPERIDOL LACTATE UDL LABORATORIES, INC. 51079080301 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080317 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080319 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080320 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080401 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080417 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080419 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080420 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080501 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079080520 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL UDL LABORATORIES, INC. 51079082320 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE UDL LABORATORIES, INC. 51079082463 PAROXETINE CR 12.5 MG TABLET 50137 PAROXETINE HCL UDL LABORATORIES, INC. 51079082562 PAROXETINE CR 25 MG TABLET 50136 PAROXETINE HCL UDL LABORATORIES, INC. 51079082563 PAROXETINE CR 25 MG TABLET 50136 PAROXETINE HCL UDL LABORATORIES, INC. 51079086501 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE UDL LABORATORIES, INC. 51079086520 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE UDL LABORATORIES, INC. 51079086601 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE UDL LABORATORIES, INC. 51079086620 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE UDL LABORATORIES, INC. 51079090001 LOXAPINE 5MG CAPSULE 3983 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079090020 LOXAPINE 5MG CAPSULE 3983 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079090101 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079090120 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079090201 LOXAPINE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079090220 LOXAPINE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079090301 LOXAPINE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079090320 LOXAPINE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE UDL LABORATORIES, INC. 51079092101 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE UDL LABORATORIES, INC. 51079092120 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE UDL LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 194 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51079092201 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE UDL LABORATORIES, INC. 51079092220 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE UDL LABORATORIES, INC. 51079094301 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL UDL LABORATORIES, INC. 51079094320 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL UDL LABORATORIES, INC. 51079094330 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL UDL LABORATORIES, INC. 51079094356 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL UDL LABORATORIES, INC. 51079094401 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL UDL LABORATORIES, INC. 51079094420 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL UDL LABORATORIES, INC. 51079096001 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL UDL LABORATORIES, INC. 51079096020 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL UDL LABORATORIES, INC. 51079097101 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL UDL LABORATORIES, INC. 51079097117 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL UDL LABORATORIES, INC. 51079097119 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL UDL LABORATORIES, INC. 51079097120 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL UDL LABORATORIES, INC. 51079098501 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL UDL LABORATORIES, INC. 51079098520 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL UDL LABORATORIES, INC. 51079098601 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL UDL LABORATORIES, INC. 51079098620 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL UDL LABORATORIES, INC. 51079099201 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE UDL LABORATORIES, INC. 51079099220 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE UDL LABORATORIES, INC. 51079099301 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE UDL LABORATORIES, INC. 51079099320 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE UDL LABORATORIES, INC. 51079099401 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL UDL LABORATORIES, INC. 51079099420 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL UDL LABORATORIES, INC. 51079099701 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL UDL LABORATORIES, INC. 51079099720 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL UDL LABORATORIES, INC. 51129462302 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 51129462402 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE LABELER NOT ON FILE 51129464602 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE LABELER NOT ON FILE 51138000130 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 51138000230 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 51138000330 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 51138000430 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 51138000530 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 51138000630 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL LABELER NOT ON FILE 51138002830 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 51138002930 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 51138003030 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 51138003130 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 195 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51138003230 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 51138009130 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 51138009330 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 51138009430 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 51138009530 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 51138020830 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 51138020930 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 51138021030 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 51138058530 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 51138058630 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 51138058730 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 51285053802 SURMONTIL 25 MG CAPSULE 46112 TRIMIPRAMINE MALEATE TEVA WOMENS HEALTH INC 51285053902 SURMONTIL 50 MG CAPSULE 46113 TRIMIPRAMINE MALEATE TEVA WOMENS HEALTH INC 51285055402 SURMONTIL 100 MG CAPSULE 46111 TRIMIPRAMINE MALEATE TEVA WOMENS HEALTH INC 51285059402 VIVACTIL 10 MG TABLET 46079 PROTRIPTYLINE HCL TEVA WOMENS HEALTH INC 51285059502 VIVACTIL 5 MG TABLET 46080 PROTRIPTYLINE HCL TEVA WOMENS HEALTH INC 51285064704 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM TEVA WOMENS HEALTH INC 51285088702 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLTEVA WOMENS HEALTH INC 51285088802 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLTEVA WOMENS HEALTH INC 51285088902 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLTEVA WOMENS HEALTH INC 51285089002 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLTEVA WOMENS HEALTH INC 51552096704 SODIUM VALPROATE POWDER 57977 VALPROATE SODIUM GALLIPOT INCORPORATED 51552096706 SODIUM VALPROATE POWDER 57977 VALPROATE SODIUM GALLIPOT INCORPORATED 51641024201 GEN-XENE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024203 GEN-XENE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024205 GEN-XENE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024211 GEN-XENE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024301 GEN-XENE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024303 GEN-XENE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024305 GEN-XENE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024311 GEN-XENE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024401 GEN-XENE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024403 GEN-XENE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024405 GEN-XENE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641024411 GEN-XENE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ALRA LABORATORIES, INC. 51641032501 MB-TAB 200MG TABLET 3713 MEPROBAMATE ALRA LABORATORIES, INC. 51641032701 MB-TAB 400MG TABLET 3714 MEPROBAMATE ALRA LABORATORIES, INC. 51641032710 MB-TAB 400MG TABLET 3714 MEPROBAMATE ALRA LABORATORIES, INC. 51655005225 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 196 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51655005226 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 51655005282 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 51655006224 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655008221 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655008224 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655008225 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655008226 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655008277 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655012124 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655012125 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655012126 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655014824 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 51655021625 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL LABELER NOT ON FILE 51655021725 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL LABELER NOT ON FILE 51655021825 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL LABELER NOT ON FILE 51655022351 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 51655022887 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL LABELER NOT ON FILE 51655024524 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 51655024624 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL LABELER NOT ON FILE 51655024724 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL LABELER NOT ON FILE 51655024824 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL LABELER NOT ON FILE 51655025024 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE LABELER NOT ON FILE 51655025130 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 51655025230 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL LABELER NOT ON FILE 51655027724 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 51655028024 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL LABELER NOT ON FILE 51655032124 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 51655032224 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 51655033324 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL LABELER NOT ON FILE 51655049025 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 51655049027 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 51655050727 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE LABELER NOT ON FILE 51655051287 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL LABELER NOT ON FILE 51655051427 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL LABELER NOT ON FILE 51655051453 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL LABELER NOT ON FILE 51655052524 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 51655063324 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 51655063424 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 51655063425 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 197 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51655063452 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 51655063487 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 51655066624 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 51655066625 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 51655076087 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE LABELER NOT ON FILE 51655079953 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL LABELER NOT ON FILE 51655080024 LORAZEPAM 1MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 51655080025 LORAZEPAM 1MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 51655080124 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 51655080125 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 51655080126 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 51655080182 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 51655082024 LORAZEPAM 2MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 51655082025 LORAZEPAM 2MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 51655082124 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 51655082125 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 51655082224 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 51655082226 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 51655082326 CHLORDIAZEPOXIDE 25 MG CAP 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 51655082380 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 51655082382 CHLORDIAZEPOXIDE 25 MG CAP 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 51655082424 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 51655083124 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 51655083324 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 51655083325 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 51655083326 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 51655083382 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 51655085424 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM LABELER NOT ON FILE 51655085426 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM LABELER NOT ON FILE 51655085524 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 51655085525 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM LABELER NOT ON FILE 51655086024 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 51655086025 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 51655086026 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 51655086082 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 51655086124 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 51655086125 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 51655086126 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 51655086182 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 198 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51655086324 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 51655086325 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 51655086326 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 51655086382 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 51655088021 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL LABELER NOT ON FILE 51655088026 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL LABELER NOT ON FILE 51655096024 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 51672400105 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672400106 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672400205 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672400206 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672400305 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672400306 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672400405 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672400406 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL TARO PHARMACEUTICALS USA, INC. 51672401101 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401105 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401106 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401201 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401205 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401206 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401301 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401305 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672401306 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL TARO PHARMACEUTICALS USA, INC. 51672404201 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM TARO PHARMACEUTICALS USA, INC. 51672404202 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM TARO PHARMACEUTICALS USA, INC. 51672404301 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM TARO PHARMACEUTICALS USA, INC. 51672404302 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM TARO PHARMACEUTICALS USA, INC. 51672404401 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM TARO PHARMACEUTICALS USA, INC. 51672413001 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413003 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413101 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413103 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413203 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413204 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413303 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413304 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672413901 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC. 51672414001 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE TARO PHARMACEUTICALS USA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 199 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 51875024001 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ROYCE LABORATORIES, INC. 51875024002 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ROYCE LABORATORIES, INC. 51875024004 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ROYCE LABORATORIES, INC. 51875024101 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ROYCE LABORATORIES, INC. 51875024102 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ROYCE LABORATORIES, INC. 51875024104 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ROYCE LABORATORIES, INC. 51875024201 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ROYCE LABORATORIES, INC. 51875024202 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ROYCE LABORATORIES, INC. 51875024204 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ROYCE LABORATORIES, INC. 51875024701 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875024702 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875024801 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875024802 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875024901 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875024902 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875025001 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875025002 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLROYCE LABORATORIES, INC. 51875036301 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036302 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036304 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036401 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036402 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036404 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036501 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036502 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ROYCE LABORATORIES, INC. 51875036504 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM ROYCE LABORATORIES, INC. 51927192900 VALPROATE SODIUM POWDER 57977 VALPROATE SODIUM LABELER NOT ON FILE 51927321000 VALPROIC ACID LIQUID 51616 VALPROIC ACID LABELER NOT ON FILE 51927436200 VALPROATE SODIUM POWDER 57977 VALPROATE SODIUM LABELER NOT ON FILE 52152019102 LOXAPINE 5 MG CAPSULE 3983 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152019105 LOXAPINE 5 MG CAPSULE 3983 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152019202 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152019205 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152019302 LOXAPINE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152019305 LOXAPINE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152019402 LOXAPINE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152019405 LOXAPINE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE ACTAVIS TOTOWA LLC 52152022202 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152022204 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL ACTAVIS TOTOWA LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 200 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52152022302 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152022304 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152022402 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152022403 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152022422 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152022604 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152022630 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152022704 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152022730 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152022804 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152022830 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152025418 MIRTAZAPINE 15 MG RPD DISLV TB 47453 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152025518 MIRTAZAPINE 30 MG ODT 47454 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152025618 MIRTAZAPINE 45 MG RPD DISLV TB 47636 MIRTAZAPINE ACTAVIS TOTOWA LLC 52152028001 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152028022 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL ACTAVIS TOTOWA LLC 52152029308 TRIMIPRAMINE 25 MG CAPSULE 46112 TRIMIPRAMINE MALEATE ACTAVIS TOTOWA LLC 52152029330 TRIMIPRAMINE 25 MG CAPSULE 46112 TRIMIPRAMINE MALEATE ACTAVIS TOTOWA LLC 52152029408 TRIMIPRAMINE 50 MG CAPSULE 46113 TRIMIPRAMINE MALEATE ACTAVIS TOTOWA LLC 52152029430 TRIMIPRAMINE 50 MG CAPSULE 46113 TRIMIPRAMINE MALEATE ACTAVIS TOTOWA LLC 52152034102 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034202 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034204 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034205 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034302 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034304 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034305 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034402 DESIPRAMINE 75 MG TABLET 46108 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034404 DESIPRAMINE 75 MG TABLET 46108 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034502 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034504 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52152034650 DESIPRAMINE 150 MG TABLET 46105 DESIPRAMINE HCL ACTAVIS TOTOWA LLC 52297095509 HM ST. JOHNS WORT 300MG 46337 ST. JOHN'S WORT FOXMEYER DRUG COMPANY 52343000305 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE GENSOURCE RX 52343000360 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE GENSOURCE RX 52343000405 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE GENSOURCE RX 52343000460 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE GENSOURCE RX 52343000505 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE GENSOURCE RX 52343000560 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE GENSOURCE RX

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 201 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52343000605 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE GENSOURCE RX 52343000660 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE GENSOURCE RX 52343000705 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE GENSOURCE RX 52343000760 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE GENSOURCE RX 52343000860 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE GENSOURCE RX 52544024001 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 52544024005 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 52544024010 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 52544024101 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 52544024105 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 52544024110 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 52544024201 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 52544024205 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 52544024210 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 52544033201 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 52544033205 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 52544033210 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM WATSON PHARMA, INC. 52544033301 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 52544033305 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 52544033310 LORAZEPAM 1MG TABLET 3758 LORAZEPAM WATSON PHARMA, INC. 52544033405 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 52544033410 LORAZEPAM 2MG TABLET 3759 LORAZEPAM WATSON PHARMA, INC. 52544036301 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544036305 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544036401 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544036405 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544036501 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544036505 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544036901 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544036910 LOXAPINE SUCCINATE 5MG CAP 3983 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544037001 LOXAPINE SUCCINATE 10MG CAP 3981 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544037101 LOXAPINE SUCCINATE 25MG CAP 3982 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544037201 LOXAPINE SUCCINATE 50MG CAP 3984 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544037301 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL WATSON PHARMA, INC. 52544037401 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL WATSON PHARMA, INC. 52544037501 MAPROTILINE 75MG TABLET 46134 MAPROTILINE HCL WATSON PHARMA, INC. 52544037901 AMOXAPINE 25MG TABLET 46083 AMOXAPINE WATSON PHARMA, INC. 52544038001 AMOXAPINE 50MG TABLET 46084 AMOXAPINE WATSON PHARMA, INC. 52544038005 AMOXAPINE 50MG TABLET 46084 AMOXAPINE WATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 202 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52544038101 AMOXAPINE 100MG TABLET 46081 AMOXAPINE WATSON PHARMA, INC. 52544038201 AMOXAPINE 150MG TABLET 46082 AMOXAPINE WATSON PHARMA, INC. 52544038230 AMOXAPINE 150MG TABLET 46082 AMOXAPINE WATSON PHARMA, INC. 52544042616 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM WATSON PHARMA, INC. 52544049401 LOXITANE 5 MG CAPSULE 3983 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544049501 LOXITANE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544049601 LOXITANE 25 MG CAPSULE 3982 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544049701 LOXITANE 50 MG CAPSULE 3984 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544054401 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL WATSON PHARMA, INC. 52544054501 DESIPRAMINE 100MG TABLET 46104 DESIPRAMINE HCL WATSON PHARMA, INC. 52544059401 CLOMIPRAMINE 25MG CAPSULE 46120 CLOMIPRAMINE HCL WATSON PHARMA, INC. 52544059501 CLOMIPRAMINE 50MG CAPSULE 46121 CLOMIPRAMINE HCL WATSON PHARMA, INC. 52544059601 CLOMIPRAMINE 75MG CAPSULE 46122 CLOMIPRAMINE HCL WATSON PHARMA, INC. 52544065701 BUSPIRONE HCL 5MG TABLET 3782 BUSPIRONE HCL WATSON PHARMA, INC. 52544065705 BUSPIRONE HCL 5MG TABLET 3782 BUSPIRONE HCL WATSON PHARMA, INC. 52544065710 BUSPIRONE HCL 5MG TABLET 3782 BUSPIRONE HCL WATSON PHARMA, INC. 52544065801 BUSPIRONE HCL 10MG TABLET 3781 BUSPIRONE HCL WATSON PHARMA, INC. 52544065805 BUSPIRONE HCL 10MG TABLET 3781 BUSPIRONE HCL WATSON PHARMA, INC. 52544065810 BUSPIRONE HCL 10MG TABLET 3781 BUSPIRONE HCL WATSON PHARMA, INC. 52544068201 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 52544068205 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 52544068210 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WATSON PHARMA, INC. 52544068301 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 52544068305 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 52544068310 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WATSON PHARMA, INC. 52544068401 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 52544068405 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 52544068410 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WATSON PHARMA, INC. 52544069501 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL WATSON PHARMA, INC. 52544069510 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL WATSON PHARMA, INC. 52544069601 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 52544069610 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL WATSON PHARMA, INC. 52544069701 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC. 52544069710 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL WATSON PHARMA, INC. 52544070601 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 52544070605 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 52544070701 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 52544070705 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 52544070801 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 203 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52544070805 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 52544070901 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 52544070905 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLWATSON PHARMA, INC. 52544078501 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 52544078505 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 52544078601 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 52544078605 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 52544078610 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 52544078701 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 52544078705 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL WATSON PHARMA, INC. 52544080401 MEPROBAMATE 200MG TABLET 3713 MEPROBAMATE WATSON PHARMA, INC. 52544080501 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 52544080510 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE WATSON PHARMA, INC. 52544080801 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 52544080805 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL WATSON PHARMA, INC. 52544080901 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 52544080905 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL WATSON PHARMA, INC. 52544081101 LOXITANE 5MG CAPSULE 3983 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544081201 LOXITANE 10MG CAPSULE 3981 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544081210 LOXITANE 10MG CAPSULE 3981 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544081301 LOXITANE 25MG CAPSULE 3982 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544081310 LOXITANE 25MG CAPSULE 3982 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544081401 LOXITANE 50MG CAPSULE 3984 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544081410 LOXITANE 50MG CAPSULE 3984 LOXAPINE SUCCINATE WATSON PHARMA, INC. 52544081534 LOXITANE C 25MG/ML CONCTR 3980 LOXAPINE HCL WATSON PHARMA, INC. 52544081679 LOXITANE IM 50MG/ML VIAL 3979 LOXAPINE HCL WATSON PHARMA, INC. 52544083501 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544083505 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544083601 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544083605 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52544083701 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM WATSON PHARMA, INC. 52555023301 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM MARTEC USA, LLC 52555025401 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL MARTEC USA, LLC 52555025501 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MARTEC USA, LLC 52555025510 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MARTEC USA, LLC 52555025601 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MARTEC USA, LLC 52555025610 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MARTEC USA, LLC 52555026005 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MARTEC USA, LLC 52555026010 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MARTEC USA, LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 204 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52555026101 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MARTEC USA, LLC 52555028601 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MARTEC USA, LLC 52555028701 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MARTEC USA, LLC 52555028801 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL MARTEC USA, LLC 52555029401 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL MARTEC USA, LLC 52555029501 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MARTEC USA, LLC 52555029601 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MARTEC USA, LLC 52555032201 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL MARTEC USA, LLC 52555032501 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MARTEC USA, LLC 52555033101 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL MARTEC USA, LLC 52555033201 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL MARTEC USA, LLC 52555035501 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL MARTEC USA, LLC 52555035601 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL MARTEC USA, LLC 52555038001 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MARTEC USA, LLC 52555038101 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MARTEC USA, LLC 52555038201 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MARTEC USA, LLC 52555043005 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM MARTEC USA, LLC 52555043101 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MARTEC USA, LLC 52555043201 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MARTEC USA, LLC 52555043505 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MARTEC USA, LLC 52555044701 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL MARTEC USA, LLC 52555044801 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MARTEC USA, LLC 52555044901 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MARTEC USA, LLC 52555046001 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLMARTEC USA, LLC 52555046005 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLMARTEC USA, LLC 52555046105 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLMARTEC USA, LLC 52555046201 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLMARTEC USA, LLC 52555046401 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLMARTEC USA, LLC 52555046405 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLMARTEC USA, LLC 52555048501 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM MARTEC USA, LLC 52555048505 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM MARTEC USA, LLC 52555048601 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MARTEC USA, LLC 52555048605 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MARTEC USA, LLC 52555048701 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MARTEC USA, LLC 52555048705 LORAZEPAM 2MG TABLET 3759 LORAZEPAM MARTEC USA, LLC 52555054001 AMOXAPINE 50MG TABLET 46084 AMOXAPINE MARTEC USA, LLC 52555054101 AMOXAPINE 100MG TABLET 46081 AMOXAPINE MARTEC USA, LLC 52555054230 AMOXAPINE 150MG TABLET 46082 AMOXAPINE MARTEC USA, LLC 52555056401 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MARTEC USA, LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 205 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52555056501 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MARTEC USA, LLC 52555056601 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL MARTEC USA, LLC 52555056901 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MARTEC USA, LLC 52555057001 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MARTEC USA, LLC 52555057101 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MARTEC USA, LLC 52555057201 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE MARTEC USA, LLC 52555058905 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM MARTEC USA, LLC 52555059701 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL MARTEC USA, LLC 52555059801 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL MARTEC USA, LLC 52555059901 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL MARTEC USA, LLC 52555065501 PROTRIPTYLINE 5MG TABLET 46080 PROTRIPTYLINE HCL MARTEC USA, LLC 52555065601 PROTRIPTYLINE 10MG TABLET 46079 PROTRIPTYLINE HCL MARTEC USA, LLC 52555066701 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MARTEC USA, LLC 52555068801 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MARTEC USA, LLC 52555072701 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MARTEC USA, LLC 52555072705 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MARTEC USA, LLC 52555072710 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MARTEC USA, LLC 52555072801 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MARTEC USA, LLC 52555072805 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MARTEC USA, LLC 52555072901 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL MARTEC USA, LLC 52555097610 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL MARTEC USA, LLC 52555097701 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MARTEC USA, LLC 52555097710 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MARTEC USA, LLC 52555097801 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL MARTEC USA, LLC 52555098601 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MARTEC USA, LLC 52555098605 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM MARTEC USA, LLC 52555098701 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MARTEC USA, LLC 52555098705 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM MARTEC USA, LLC 52555098801 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM MARTEC USA, LLC 52569012905 HM ST. JOHNS WORT 300 MG 46337 ST. JOHN'S WORT GENERAMED, INC. 52959000802 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959000815 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959000820 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959000830 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959000840 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959000850 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959000860 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959000890 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHARMA PAC 52959001000 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 206 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959001030 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHARMA PAC 52959001060 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHARMA PAC 52959004701 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004703 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004705 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004706 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004710 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004712 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004715 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004720 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004721 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004725 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004730 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004740 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004745 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004750 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004760 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959004790 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHARMA PAC 52959012830 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL PHARMA PAC 52959014030 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHARMA PAC 52959014060 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHARMA PAC 52959014090 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHARMA PAC 52959014242 DEPAKOTE EC 125 MG TABLET 4538 DIVALPROEX SODIUM PHARMA PAC 52959016220 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959016330 PAMELOR 25 MG CAPSULE 46060 NORTRIPTYLINE HCL PHARMA PAC 52959017330 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL PHARMA PAC 52959023300 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHARMA PAC 52959023310 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHARMA PAC 52959023314 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHARMA PAC 52959023320 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHARMA PAC 52959023330 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHARMA PAC 52959023340 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHARMA PAC 52959023350 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHARMA PAC 52959028400 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL PHARMA PAC 52959028530 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PHARMA PAC 52959028560 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PHARMA PAC 52959029502 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHARMA PAC 52959029510 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHARMA PAC 52959029515 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 207 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959029530 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHARMA PAC 52959029550 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHARMA PAC 52959030600 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHARMA PAC 52959030606 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHARMA PAC 52959030615 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHARMA PAC 52959030620 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHARMA PAC 52959030630 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHARMA PAC 52959030660 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHARMA PAC 52959030690 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHARMA PAC 52959032100 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032102 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032110 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032114 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032120 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032130 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032160 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032190 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959032230 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PHARMA PAC 52959033100 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033104 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033105 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033110 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033114 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033115 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033120 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033121 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033130 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033145 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033160 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959033190 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHARMA PAC 52959034800 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034810 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034812 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034814 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034815 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034820 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034830 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034850 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959034860 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 208 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959034890 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHARMA PAC 52959035000 DESYREL 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959035020 DESYREL 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959035030 DESYREL 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959035610 HALDOL 1MG TABLET 3973 HALOPERIDOL PHARMA PAC 52959035802 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHARMA PAC 52959035820 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHARMA PAC 52959035830 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHARMA PAC 52959035860 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHARMA PAC 52959035890 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHARMA PAC 52959035902 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHARMA PAC 52959035920 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHARMA PAC 52959035930 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHARMA PAC 52959035950 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHARMA PAC 52959035960 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHARMA PAC 52959035990 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHARMA PAC 52959036012 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PHARMA PAC 52959036015 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PHARMA PAC 52959036020 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PHARMA PAC 52959036030 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PHARMA PAC 52959036060 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PHARMA PAC 52959036100 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHARMA PAC 52959036114 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHARMA PAC 52959036130 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHARMA PAC 52959036160 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHARMA PAC 52959036501 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHARMA PAC 52959036505 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHARMA PAC 52959036515 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHARMA PAC 52959036530 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHARMA PAC 52959036560 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHARMA PAC 52959036590 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHARMA PAC 52959037815 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959037820 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959037830 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959037860 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959037890 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHARMA PAC 52959038830 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHARMA PAC 52959038860 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHARMA PAC 52959039630 ELAVIL 10 MG TABLET 46043 AMITRIPTYLINE HCL PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 209 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959043030 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE PHARMA PAC 52959043060 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE PHARMA PAC 52959045700 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045702 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045715 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045720 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045728 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045730 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045742 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045745 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045760 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045790 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHARMA PAC 52959045814 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PHARMA PAC 52959045820 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PHARMA PAC 52959045821 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PHARMA PAC 52959046400 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL PHARMA PAC 52959046412 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL PHARMA PAC 52959046414 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL PHARMA PAC 52959046420 DESIPRAMINE 50 MG TABLET 46107 DESIPRAMINE HCL PHARMA PAC 52959051400 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051401 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051410 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051420 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051421 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051430 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051460 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051490 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHARMA PAC 52959051810 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL PHARMA PAC 52959051915 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHARMA PAC 52959051930 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHARMA PAC 52959051960 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHARMA PAC 52959052400 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959052402 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959052406 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959052410 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959052414 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959052428 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959052430 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959052460 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 210 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959052490 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHARMA PAC 52959053730 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PHARMA PAC 52959053790 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PHARMA PAC 52959053800 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHARMA PAC 52959053810 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHARMA PAC 52959053820 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHARMA PAC 52959053830 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHARMA PAC 52959053840 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHARMA PAC 52959053860 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHARMA PAC 52959053890 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHARMA PAC 52959054110 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PHARMA PAC 52959054120 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PHARMA PAC 52959054130 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PHARMA PAC 52959054160 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PHARMA PAC 52959054214 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHARMA PAC 52959054215 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHARMA PAC 52959054228 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHARMA PAC 52959054230 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHARMA PAC 52959054240 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHARMA PAC 52959054242 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHARMA PAC 52959055030 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHARMA PAC 52959055060 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHARMA PAC 52959057930 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE PHARMA PAC 52959060330 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHARMA PAC 52959060430 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE PHARMA PAC 52959060530 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE PHARMA PAC 52959060630 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL PHARMA PAC 52959060660 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL PHARMA PAC 52959063804 PROZAC WEEKLY 90 MG CAPSULE 47571 FLUOXETINE HCL PHARMA PAC 52959063930 PAXIL 10 MG TABLET 46222 PAROXETINE HCL PHARMA PAC 52959064590 SERZONE 100 MG TABLET 46254 NEFAZODONE HCL PHARMA PAC 52959065430 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PHARMA PAC 52959065502 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHARMA PAC 52959065530 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHARMA PAC 52959065540 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHARMA PAC 52959065560 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHARMA PAC 52959065590 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHARMA PAC 52959066230 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PHARMA PAC 52959066530 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 211 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959066930 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHARMA PAC 52959066959 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHARMA PAC 52959066960 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHARMA PAC 52959067160 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PHARMA PAC 52959067660 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHARMA PAC 52959068660 BUSPAR 15 MG TABLET 27378 BUSPIRONE HCL PHARMA PAC 52959068760 BUSPAR 30 MG TABLET 44210 BUSPIRONE HCL PHARMA PAC 52959070300 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHARMA PAC 52959070330 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHARMA PAC 52959070360 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHARMA PAC 52959070400 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHARMA PAC 52959070430 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHARMA PAC 52959070460 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHARMA PAC 52959071300 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHARMA PAC 52959071330 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHARMA PAC 52959071345 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHARMA PAC 52959071360 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHARMA PAC 52959071390 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHARMA PAC 52959071730 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PHARMA PAC 52959073200 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073210 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073214 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073215 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073220 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073230 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073240 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073250 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959073260 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHARMA PAC 52959077160 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL PHARMA PAC 52959077330 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHARMA PAC 52959077352 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHARMA PAC 52959077360 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHARMA PAC 52959077430 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PHARMA PAC 52959077460 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PHARMA PAC 52959077530 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PHARMA PAC 52959077550 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PHARMA PAC 52959077560 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PHARMA PAC 52959077630 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHARMA PAC 52959077660 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 212 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959078130 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHARMA PAC 52959078160 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHARMA PAC 52959078730 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL PHARMA PAC 52959079130 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL PHARMA PAC 52959079230 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL PHARMA PAC 52959080560 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL PHARMA PAC 52959080630 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHARMA PAC 52959080660 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHARMA PAC 52959081830 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PHARMA PAC 52959081860 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PHARMA PAC 52959082060 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL PHARMA PAC 52959083460 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL PHARMA PAC 52959083790 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PHARMA PAC 52959084060 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL PHARMA PAC 52959086400 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHARMA PAC 52959086410 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHARMA PAC 52959086430 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHARMA PAC 52959086440 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHARMA PAC 52959086460 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHARMA PAC 52959086490 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHARMA PAC 52959086930 BUDEPRION XL 300 MG TABLET 53007 BUPROPION HCL PHARMA PAC 52959087230 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PHARMA PAC 52959087260 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PHARMA PAC 52959087330 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHARMA PAC 52959087360 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHARMA PAC 52959087460 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PHARMA PAC 52959087560 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHARMA PAC 52959088730 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PHARMA PAC 52959089030 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHARMA PAC 52959089060 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHARMA PAC 52959089090 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHARMA PAC 52959089230 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHARMA PAC 52959089260 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHARMA PAC 52959089430 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHARMA PAC 52959089860 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PHARMA PAC 52959090130 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PHARMA PAC 52959091630 RISPERDAL 2 MG TABLET 21155 RISPERIDONE PHARMA PAC 52959091660 RISPERDAL 2 MG TABLET 21155 RISPERIDONE PHARMA PAC 52959094060 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE PHARMA PAC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 213 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 52959094130 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE PHARMA PAC 52959094160 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE PHARMA PAC 52959096515 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM PHARMA PAC 52959096530 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM PHARMA PAC 52959096560 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM PHARMA PAC 52959098630 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHARMA PAC 53265004810 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ABLE LABORATORIES INC. 53265004850 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ABLE LABORATORIES INC. 53265004910 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ABLE LABORATORIES INC. 53265004950 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ABLE LABORATORIES INC. 53265005010 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ABLE LABORATORIES INC. 53265027010 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265027011 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265028303 LITHIUM 300 MG ER TABLET 4004 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265028310 LITHIUM 300 MG ER TABLET 4004 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265028311 LITHIUM 300 MG ER TABLET 4004 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265028350 LITHIUM 300 MG ER TABLET 4004 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265030110 FLUPHENAZINE 25 MG/ML VIAL 3818 FLUPHENAZINE DECANOATE ABLE LABORATORIES INC. 53265035510 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265035550 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265035610 LITHIUM CARBONATE 600 MG CAP 4002 LITHIUM CARBONATE ABLE LABORATORIES INC. 53265044451 HALOPERIDOL DEC 50 MG/ML VL 3967 HALOPERIDOL DECANOATE ABLE LABORATORIES INC. 53265044456 HALOPERIDOL DEC 50 MG/ML VL 3967 HALOPERIDOL DECANOATE ABLE LABORATORIES INC. 53265054451 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE ABLE LABORATORIES INC. 53265054456 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE ABLE LABORATORIES INC. 53265064456 FLUPHENAZINE DEC 25 MG/ML VL 3818 FLUPHENAZINE DECANOATE ABLE LABORATORIES INC. 53445081801 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLAMERICAN PREFERRED PHARMACEUTICAL INC 53445081901 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLAMERICAN PREFERRED PHARMACEUTICAL INC 53445082001 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLAMERICAN PREFERRED PHARMACEUTICAL INC 53445082101 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLAMERICAN PREFERRED PHARMACEUTICAL INC 53445125901 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL AMERICAN PREFERRED PHARMACEUTICAL INC 53445126001 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL AMERICAN PREFERRED PHARMACEUTICAL INC 53445163800 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL AMERICAN PREFERRED PHARMACEUTICAL INC 53445163901 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL AMERICAN PREFERRED PHARMACEUTICAL INC 53489010401 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010410 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010501 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010510 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010601 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 214 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 53489010610 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010701 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010705 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010801 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489010901 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489014801 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489014810 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489014901 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489014910 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489015001 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489015010 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033001 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033003 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033010 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033101 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033103 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033110 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033201 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033203 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489033210 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489035701 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MUTUAL PHARMACEUTICAL COMPANY 53489035705 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MUTUAL PHARMACEUTICAL COMPANY 53489035801 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MUTUAL PHARMACEUTICAL COMPANY 53489035805 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MUTUAL PHARMACEUTICAL COMPANY 53489035810 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MUTUAL PHARMACEUTICAL COMPANY 53489035901 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MUTUAL PHARMACEUTICAL COMPANY 53489035905 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MUTUAL PHARMACEUTICAL COMPANY 53489037301 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037305 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037306 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037307 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037310 FLUOXETINE HCL 10MG CAPSULE 46213 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037401 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037405 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037406 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037407 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489037410 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489050001 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051001 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 215 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 53489051005 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051010 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051101 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051105 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051110 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051701 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051703 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53489051705 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL MUTUAL PHARMACEUTICAL COMPANY 53978500809 LORAZEPAM 1MG TABLET 3758 LORAZEPAM MED-PRO INCORPORATED 54092041912 EQUETRO 100 MG CAPSULE 64364 CARBAMAZEPINE SHIRE US, INC. 54092042112 EQUETRO 200 MG CAPSULE 64365 CARBAMAZEPINE SHIRE US, INC. 54092042312 EQUETRO 300 MG CAPSULE 64366 CARBAMAZEPINE SHIRE US, INC. 54092051302 INTUNIV ER 1 MG TABLET 65570 GUANFACINE HCL SHIRE US, INC. 54092051502 INTUNIV ER 2 MG TABLET 65572 GUANFACINE HCL SHIRE US, INC. 54092051702 INTUNIV ER 3 MG TABLET 65573 GUANFACINE HCL SHIRE US, INC. 54092051902 INTUNIV ER 4 MG TABLET 65574 GUANFACINE HCL SHIRE US, INC. 54429319401 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID CHASE LABORATORIES, INC. 54458010024 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT INTERNATIONAL LABS, INC. 54458089802 ST. JOHN'S WORT 25 MG/ML DRP 46340 ST. JOHN'S WORT INTERNATIONAL LABS, INC. 54458091202 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE INTERNATIONAL LABS, INC. 54458091302 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL INTERNATIONAL LABS, INC. 54458092205 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE INTERNATIONAL LABS, INC. 54458092405 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL INTERNATIONAL LABS, INC. 54458094405 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL INTERNATIONAL LABS, INC. 54458094410 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL INTERNATIONAL LABS, INC. 54458094510 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL INTERNATIONAL LABS, INC. 54458094710 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL INTERNATIONAL LABS, INC. 54458096010 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL INTERNATIONAL LABS, INC. 54458096110 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL INTERNATIONAL LABS, INC. 54458098005 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE INTERNATIONAL LABS, INC. 54458098010 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE INTERNATIONAL LABS, INC. 54458098110 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE INTERNATIONAL LABS, INC. 54458098810 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL INTERNATIONAL LABS, INC. 54458098904 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL INTERNATIONAL LABS, INC. 54458098910 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL INTERNATIONAL LABS, INC. 54458099010 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL INTERNATIONAL LABS, INC. 54569017100 ELAVIL 10MG TABLET 46043 AMITRIPTYLINE HCL ALLSCRIPTS 54569017200 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ALLSCRIPTS 54569017201 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 216 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569017202 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL ALLSCRIPTS 54569017204 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ALLSCRIPTS 54569017206 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ALLSCRIPTS 54569017207 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ALLSCRIPTS 54569017208 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ALLSCRIPTS 54569017300 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEALLSCRIPTS 54569017301 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEALLSCRIPTS 54569017400 ELAVIL 25MG TABLET 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017500 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017501 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017502 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017503 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017504 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017505 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017506 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569017508 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ALLSCRIPTS 54569018000 LITHONATE 300MG CAPSULE 4001 LITHIUM CARBONATE ALLSCRIPTS 54569018005 LITHONATE 300MG CAPSULE 4001 LITHIUM CARBONATE ALLSCRIPTS 54569018900 SINEQUAN 50MG CAPSULE 46090 DOXEPIN HCL ALLSCRIPTS 54569019400 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL ALLSCRIPTS 54569019401 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ALLSCRIPTS 54569019402 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ALLSCRIPTS 54569019404 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ALLSCRIPTS 54569019405 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL ALLSCRIPTS 54569019601 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ALLSCRIPTS 54569019602 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ALLSCRIPTS 54569019603 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ALLSCRIPTS 54569019604 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL ALLSCRIPTS 54569022500 PAMELOR 10MG CAPSULE 46059 NORTRIPTYLINE HCL ALLSCRIPTS 54569022601 PAMELOR 25MG CAPSULE 46060 NORTRIPTYLINE HCL ALLSCRIPTS 54569022603 PAMELOR 25MG CAPSULE 46060 NORTRIPTYLINE HCL ALLSCRIPTS 54569022604 PAMELOR 25MG CAPSULE 46060 NORTRIPTYLINE HCL ALLSCRIPTS 54569026100 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM ALLSCRIPTS 54569026101 DEPAKOTE 250MG TABLET EC 4539 DIVALPROEX SODIUM ALLSCRIPTS 54569026103 DEPAKOTE 250MG TABLET EC 4539 DIVALPROEX SODIUM ALLSCRIPTS 54569026104 DEPAKOTE 250MG TABLET EC 4539 DIVALPROEX SODIUM ALLSCRIPTS 54569026200 DEPAKOTE 500MG TABLET EC 4540 DIVALPROEX SODIUM ALLSCRIPTS 54569026201 DEPAKOTE 500MG TABLET EC 4540 DIVALPROEX SODIUM ALLSCRIPTS 54569040400 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 217 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569040401 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL ALLSCRIPTS 54569040403 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL ALLSCRIPTS 54569062401 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569062402 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569092701 ATIVAN 1 MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569093200 LIBRIUM 10MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569093300 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569093500 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE ALLSCRIPTS 54569093501 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE ALLSCRIPTS 54569093502 MEPROBAMATE 400 MG TABLET 3714 MEPROBAMATE ALLSCRIPTS 54569093600 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093601 DIAZEPAM 10MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093602 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093603 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093604 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093605 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093606 DIAZEPAM 10MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093607 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093608 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569093609 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569094600 VALIUM 2MG TABLET 3767 DIAZEPAM ALLSCRIPTS 54569094700 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM ALLSCRIPTS 54569094702 DIAZEPAM 2MG TABLET 3767 DIAZEPAM ALLSCRIPTS 54569094703 DIAZEPAM 2MG TABLET 3767 DIAZEPAM ALLSCRIPTS 54569094705 DIAZEPAM 2MG TABLET 3767 DIAZEPAM ALLSCRIPTS 54569094800 VALIUM 5MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094801 VALIUM 5MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094804 VALIUM 5MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094900 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094901 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094902 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094903 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094904 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094905 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094906 DIAZEPAM 5MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094907 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569094908 DIAZEPAM 5MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569095000 VALIUM 10MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569095101 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 218 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569095103 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM ALLSCRIPTS 54569095201 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALLSCRIPTS 54569095204 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM ALLSCRIPTS 54569095300 XANAX 0.25MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569095303 XANAX 0.25MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569095306 XANAX 0.25MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569095307 XANAX 0.25MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569095400 XANAX 0.5MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569095402 XANAX 0.5MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569095403 XANAX 0.5MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569095404 XANAX 0.5MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569095406 XANAX 0.5MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569095407 XANAX 0.5MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569095503 BUSPAR 5MG TABLET 3782 BUSPIRONE HCL ALLSCRIPTS 54569141000 VALIUM 5MG/ML VIAL 3763 DIAZEPAM ALLSCRIPTS 54569141300 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM ALLSCRIPTS 54569147000 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ALLSCRIPTS 54569147001 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ALLSCRIPTS 54569147005 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL ALLSCRIPTS 54569147006 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ALLSCRIPTS 54569147007 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ALLSCRIPTS 54569147008 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ALLSCRIPTS 54569147009 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ALLSCRIPTS 54569147900 PROLIXIN DECANOATE 25MG/ML 3818 FLUPHENAZINE DECANOATE ALLSCRIPTS 54569151900 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ALLSCRIPTS 54569151901 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL ALLSCRIPTS 54569151902 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ALLSCRIPTS 54569151903 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL ALLSCRIPTS 54569156100 HALDOL DECANOATE 50 AMPUL 3966 HALOPERIDOL DECANOATE ALLSCRIPTS 54569158500 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158501 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158502 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158503 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158504 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158505 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158506 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158507 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158508 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569158509 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 219 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569160000 HALDOL 1MG TABLET 3973 HALOPERIDOL ALLSCRIPTS 54569160100 HALDOL 2MG TABLET 3975 HALOPERIDOL ALLSCRIPTS 54569160600 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569160601 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569160602 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569169600 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL ALLSCRIPTS 54569169601 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL ALLSCRIPTS 54569170102 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL ALLSCRIPTS 54569173200 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569173202 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569173203 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569173204 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569173205 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569173206 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569176900 XANAX 1MG TABLET 3775 ALPRAZOLAM ALLSCRIPTS 54569176901 XANAX 1MG TABLET 3775 ALPRAZOLAM ALLSCRIPTS 54569186401 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL ALLSCRIPTS 54569186402 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL ALLSCRIPTS 54569190700 PAMELOR 50MG CAPSULE 46061 NORTRIPTYLINE HCL ALLSCRIPTS 54569198501 INAPSINE 2.5MG/ML AMPUL 3964 DROPERIDOL ALLSCRIPTS 54569199900 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL ALLSCRIPTS 54569199901 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL ALLSCRIPTS 54569199902 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL ALLSCRIPTS 54569199903 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL ALLSCRIPTS 54569200600 NORPRAMIN 10MG TABLET 46103 DESIPRAMINE HCL ALLSCRIPTS 54569208900 THORAZINE 25MG/ML AMPUL 3788 CHLORPROMAZINE HCL ALLSCRIPTS 54569209502 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569209503 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569209504 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569209505 CHLORDIAZEPOXIDE 25 MG CAP 3735 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569209506 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL ALLSCRIPTS 54569214600 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL ALLSCRIPTS 54569214601 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL ALLSCRIPTS 54569214602 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL ALLSCRIPTS 54569217300 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM ALLSCRIPTS 54569217301 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ALLSCRIPTS 54569217302 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ALLSCRIPTS 54569217303 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ALLSCRIPTS 54569217304 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 220 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569217900 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL ALLSCRIPTS 54569217901 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL ALLSCRIPTS 54569217903 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL ALLSCRIPTS 54569222400 VALIUM 5MG/ML SYRINGE 3762 DIAZEPAM ALLSCRIPTS 54569246200 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL ALLSCRIPTS 54569246201 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL ALLSCRIPTS 54569268700 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM ALLSCRIPTS 54569268701 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ALLSCRIPTS 54569268704 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ALLSCRIPTS 54569270500 VALIUM 5MG/ML VIAL 3763 DIAZEPAM ALLSCRIPTS 54569272600 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL ALLSCRIPTS 54569272602 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL ALLSCRIPTS 54569274001 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL ALLSCRIPTS 54569274100 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL ALLSCRIPTS 54569277500 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM ALLSCRIPTS 54569288301 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL ALLSCRIPTS 54569288302 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL ALLSCRIPTS 54569297800 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL ALLSCRIPTS 54569298103 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM ALLSCRIPTS 54569298105 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM ALLSCRIPTS 54569318700 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL ALLSCRIPTS 54569319001 WELLBUTRIN 100MG TABLET 46237 BUPROPION HCL ALLSCRIPTS 54569327000 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLALLSCRIPTS 54569357302 WELLBUTRIN 75MG TABLET 46236 BUPROPION HCL ALLSCRIPTS 54569357304 WELLBUTRIN 75MG TABLET 46236 BUPROPION HCL ALLSCRIPTS 54569357500 ZOLOFT 100MG TABLET 46229 SERTRALINE HCL ALLSCRIPTS 54569357501 ZOLOFT 100MG TABLET 46229 SERTRALINE HCL ALLSCRIPTS 54569357502 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL ALLSCRIPTS 54569357503 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL ALLSCRIPTS 54569372400 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569372401 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569372402 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569372403 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569372404 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569372405 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569373201 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL ALLSCRIPTS 54569373202 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL ALLSCRIPTS 54569373203 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL ALLSCRIPTS 54569375500 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 221 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569375501 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569375502 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569375503 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569375504 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569375505 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM ALLSCRIPTS 54569375600 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569375601 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569375602 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569375603 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569375604 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM ALLSCRIPTS 54569381000 PAXIL 20 MG TABLET 46223 PAROXETINE HCL ALLSCRIPTS 54569381001 PAXIL 20MG TABLET 46223 PAROXETINE HCL ALLSCRIPTS 54569384900 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL ALLSCRIPTS 54569384901 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL ALLSCRIPTS 54569384902 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL ALLSCRIPTS 54569390700 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL ALLSCRIPTS 54569412600 SERZONE 100MG TABLET 46254 NEFAZODONE HCL ALLSCRIPTS 54569412601 SERZONE 100MG TABLET 46254 NEFAZODONE HCL ALLSCRIPTS 54569412700 SERZONE 150MG TABLET 46255 NEFAZODONE HCL ALLSCRIPTS 54569412701 SERZONE 150MG TABLET 46255 NEFAZODONE HCL ALLSCRIPTS 54569412800 STELAZINE 1MG TABLET 3851 TRIFLUOPERAZINE HCL ALLSCRIPTS 54569412900 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL ALLSCRIPTS 54569413101 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL ALLSCRIPTS 54569413200 EFFEXOR 75MG TABLET 46401 VENLAFAXINE HCL ALLSCRIPTS 54569413201 EFFEXOR 75MG TABLET 46401 VENLAFAXINE HCL ALLSCRIPTS 54569413400 DEPAKOTE 125MG TABLET EC 4538 DIVALPROEX SODIUM ALLSCRIPTS 54569413500 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE ALLSCRIPTS 54569413700 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLALLSCRIPTS 54569414600 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL ALLSCRIPTS 54569414601 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL ALLSCRIPTS 54569414800 PAXIL 30MG TABLET 46224 PAROXETINE HCL ALLSCRIPTS 54569416700 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM ALLSCRIPTS 54569419500 SERZONE 200MG TABLET 46256 NEFAZODONE HCL ALLSCRIPTS 54569419501 SERZONE 200MG TABLET 46256 NEFAZODONE HCL ALLSCRIPTS 54569422500 EFFEXOR 50MG TABLET 46400 VENLAFAXINE HCL ALLSCRIPTS 54569452100 WELLBUTRIN SR 150MG TAB SA 46238 BUPROPION HCL ALLSCRIPTS 54569452101 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL ALLSCRIPTS 54569452102 WELLBUTRIN SR 150MG TAB SA 46238 BUPROPION HCL ALLSCRIPTS 54569452103 WELLBUTRIN SR 150MG TAB SA 46238 BUPROPION HCL ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 222 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569452900 ZOLOFT 25MG TABLET 46227 SERTRALINE HCL ALLSCRIPTS 54569452901 ZOLOFT 25MG TABLET 46227 SERTRALINE HCL ALLSCRIPTS 54569452902 ZOLOFT 25MG TABLET 46227 SERTRALINE HCL ALLSCRIPTS 54569458600 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ALLSCRIPTS 54569458601 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM ALLSCRIPTS 54569459400 SERZONE 250MG TABLET 46257 NEFAZODONE HCL ALLSCRIPTS 54569461900 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ALLSCRIPTS 54569461901 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ALLSCRIPTS 54569461902 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ALLSCRIPTS 54569461903 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ALLSCRIPTS 54569461906 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM ALLSCRIPTS 54569465900 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL ALLSCRIPTS 54569470300 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE ALLSCRIPTS 54569470301 CELEXA 20MG TABLET 46203 CITALOPRAM HYDROBROMIDE ALLSCRIPTS 54569476400 DIAZEPAM 5MG TABLET 3768 DIAZEPAM ALLSCRIPTS 54569477700 ST. JOHN'S WORT 300MG CAP 46333 ST. JOHN'S WORT ALLSCRIPTS 54569478700 PAXIL 10 MG TABLET 46222 PAROXETINE HCL ALLSCRIPTS 54569485400 ST. JOHN'S WORT 450 MG CAP 46335 ST. JOHN'S WORT ALLSCRIPTS 54569487900 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE ALLSCRIPTS 54569490000 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM ALLSCRIPTS 54569490001 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM ALLSCRIPTS 54569490002 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM ALLSCRIPTS 54569490100 PAXIL 40 MG TABLET 46225 PAROXETINE HCL ALLSCRIPTS 54569490101 PAXIL 40MG TABLET 46225 PAROXETINE HCL ALLSCRIPTS 54569522300 BUSPAR 15 MG TABLET 27378 BUSPIRONE HCL ALLSCRIPTS 54569523100 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL ALLSCRIPTS 54569523900 PROZAC WEEKLY 90 MG CAPSULE 47571 FLUOXETINE HCL ALLSCRIPTS 54569525300 BUSPIRONE HCL 10MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569525301 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569525302 BUSPIRONE HCL 10MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569525303 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569525304 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569525305 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ALLSCRIPTS 54569526500 EFFEXOR XR 37.5MG CAP SA 46403 VENLAFAXINE HCL ALLSCRIPTS 54569529100 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569529101 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569529103 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL ALLSCRIPTS 54569531900 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL ALLSCRIPTS 54569531902 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 223 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569532000 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL ALLSCRIPTS 54569532001 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL ALLSCRIPTS 54569534000 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL ALLSCRIPTS 54569534001 WELLBUTRIN SR 100MG TAB SA 46239 BUPROPION HCL ALLSCRIPTS 54569535100 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM ALLSCRIPTS 54569535403 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569535404 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ALLSCRIPTS 54569539100 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL ALLSCRIPTS 54569539103 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL ALLSCRIPTS 54569540100 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569540102 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569540104 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ALLSCRIPTS 54569548300 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE ALLSCRIPTS 54569548400 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE ALLSCRIPTS 54569554100 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL ALLSCRIPTS 54569554101 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL ALLSCRIPTS 54569556800 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL ALLSCRIPTS 54569556900 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ALLSCRIPTS 54569559800 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL ALLSCRIPTS 54569559900 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL ALLSCRIPTS 54569562600 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE ALLSCRIPTS 54569562700 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE ALLSCRIPTS 54569567800 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ALLSCRIPTS 54569568200 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL ALLSCRIPTS 54569569101 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE ALLSCRIPTS 54569569201 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE ALLSCRIPTS 54569569301 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE ALLSCRIPTS 54569570700 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE ALLSCRIPTS 54569578600 NIRAVAM 0.5 MG ODT 58848 ALPRAZOLAM ALLSCRIPTS 54569578700 NIRAVAM 1 MG ODT 58849 ALPRAZOLAM ALLSCRIPTS 54569581800 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569581801 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569581802 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL ALLSCRIPTS 54569581900 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ALLSCRIPTS 54569581901 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ALLSCRIPTS 54569581902 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL ALLSCRIPTS 54569589500 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE ALLSCRIPTS 54569589800 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL ALLSCRIPTS 54569596800 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE ALLSCRIPTS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 224 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54569596801 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE ALLSCRIPTS 54569596802 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE ALLSCRIPTS 54569596900 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL ALLSCRIPTS 54569604400 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM ALLSCRIPTS 54569618700 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM ALLSCRIPTS 54569619200 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL ALLSCRIPTS 54569622600 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL ALLSCRIPTS 54569622700 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL ALLSCRIPTS 54569623300 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM ALLSCRIPTS 54569624400 NUVIGIL 150 MG TABLET 62819 ARMODAFINIL ALLSCRIPTS 54569870200 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ALLSCRIPTS 54569870300 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL ALLSCRIPTS 54569870301 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL ALLSCRIPTS 54629001445 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT NATIONAL VITAMIN COMPANY INCORPORATED 54629066445 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT NATIONAL VITAMIN COMPANY INCORPORATED 54629068200 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT NATIONAL VITAMIN COMPANY INCORPORATED 54738043601 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL RICHMOND PHARMACEUTICALS, INC. 54738043603 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL RICHMOND PHARMACEUTICALS, INC. 54738043701 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL RICHMOND PHARMACEUTICALS, INC. 54738043703 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL RICHMOND PHARMACEUTICALS, INC. 54738055001 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738055002 PERPHENAZINE 2 MG TABLET 3831 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738055101 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738055102 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738055201 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738055202 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738055301 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738055302 PERPHENAZINE 16 MG TABLET 3830 PERPHENAZINE RICHMOND PHARMACEUTICALS, INC. 54738091201 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL RICHMOND PHARMACEUTICALS, INC. 54738091301 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL RICHMOND PHARMACEUTICALS, INC. 54738091401 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL RICHMOND PHARMACEUTICALS, INC. 54738093201 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM RICHMOND PHARMACEUTICALS, INC. 54738093202 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM RICHMOND PHARMACEUTICALS, INC. 54738093301 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM RICHMOND PHARMACEUTICALS, INC. 54738093302 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM RICHMOND PHARMACEUTICALS, INC. 54738094101 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM RICHMOND PHARMACEUTICALS, INC. 54738094102 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM RICHMOND PHARMACEUTICALS, INC. 54807082001 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL R.I.D., INC. 54807082101 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL R.I.D., INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 225 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54807082201 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL R.I.D., INC. 54807082301 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL R.I.D., INC. 54807082401 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL R.I.D., INC. 54838050115 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE SILARX PHARMACEUTICALS, INC. 54838050140 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE SILARX PHARMACEUTICALS, INC. 54838051240 DOXEPIN 10 MG/ML ORAL CONC 46092 DOXEPIN HCL SILARX PHARMACEUTICALS, INC. 54838052340 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL SILARX PHARMACEUTICALS, INC. 54838054070 CITALOPRAM HBR 10 MG/5 ML SOLN 46205 CITALOPRAM HYDROBROMIDE SILARX PHARMACEUTICALS, INC. 54838054770 CITALOPRAM 10 MG/5 ML SOLUTION 46205 CITALOPRAM HYDROBROMIDE SILARX PHARMACEUTICALS, INC. 54868005900 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005901 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005902 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005903 DIAZEPAM 5MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005904 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005905 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005906 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005908 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868005909 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868006102 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIANS TC. 54868006103 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIANS TC. 54868006104 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIANS TC. 54868006105 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIANS TC. 54868006106 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PHYSICIANS TC. 54868006200 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PHYSICIANS TC. 54868006202 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PHYSICIANS TC. 54868006204 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PHYSICIANS TC. 54868006402 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006403 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006404 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006405 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006406 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006407 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006500 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006502 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006503 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006504 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006505 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006507 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006508 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 226 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868006509 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006600 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006602 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006603 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006605 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006606 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006607 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PHYSICIANS TC. 54868006700 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL PHYSICIANS TC. 54868006704 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL PHYSICIANS TC. 54868006705 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL PHYSICIANS TC. 54868007000 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868007002 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868009101 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL PHYSICIANS TC. 54868009102 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL PHYSICIANS TC. 54868012200 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIANS TC. 54868012202 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIANS TC. 54868012203 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIANS TC. 54868012204 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIANS TC. 54868012205 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIANS TC. 54868012206 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIANS TC. 54868012207 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PHYSICIANS TC. 54868012402 AMITRIP-PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLPHYSICIANS TC. 54868012403 AMITRIP-PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLPHYSICIANS TC. 54868012502 AMITRIP-PERPHEN 25-2 MG TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLPHYSICIANS TC. 54868012503 AMITRIP-PERPHEN 25-2 MG TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLPHYSICIANS TC. 54868012504 AMITRIP-PERPHEN 25-2 MG TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLPHYSICIANS TC. 54868012505 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLPHYSICIANS TC. 54868040900 ELAVIL 25 MG TABLET 46046 AMITRIPTYLINE HCL PHYSICIANS TC. 54868042600 LIMBITROL DS TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEPHYSICIANS TC. 54868050100 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEPHYSICIANS TC. 54868051100 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868051101 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868051102 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868051105 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868052201 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868052202 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868052203 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868052204 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868052205 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 227 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868052206 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868052207 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868052208 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868061700 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868061701 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868061702 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868070300 VALIUM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868070301 VALIUM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868070302 VALIUM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868070303 VALIUM 5 MG TABLET 3768 DIAZEPAM PHYSICIANS TC. 54868071600 VALIUM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868080200 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868080201 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868080202 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868080203 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868098700 VALIUM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098701 VALIUM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098800 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098801 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098802 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098803 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098804 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098805 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098806 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098807 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098808 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868098809 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PHYSICIANS TC. 54868099200 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868099201 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868099202 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868099203 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868099204 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868101901 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL PHYSICIANS TC. 54868109802 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL PHYSICIANS TC. 54868109900 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868109902 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868109903 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868120801 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PHYSICIANS TC. 54868120803 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 228 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868120804 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PHYSICIANS TC. 54868120805 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PHYSICIANS TC. 54868120806 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PHYSICIANS TC. 54868122300 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHYSICIANS TC. 54868122301 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHYSICIANS TC. 54868122303 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHYSICIANS TC. 54868122304 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PHYSICIANS TC. 54868123900 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868123901 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868123902 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868123903 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868123904 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868125100 XANAX 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868125101 XANAX 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868125102 XANAX 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868133500 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE PHYSICIANS TC. 54868133502 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE PHYSICIANS TC. 54868133503 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE PHYSICIANS TC. 54868133504 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE PHYSICIANS TC. 54868133505 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE PHYSICIANS TC. 54868133600 ESKALITH 300 MG CAPSULE 4001 LITHIUM CARBONATE PHYSICIANS TC. 54868133800 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133801 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133802 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133803 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133804 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133806 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133807 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133808 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133809 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133900 ATIVAN 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133901 ATIVAN 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133902 ATIVAN 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133904 ATIVAN 1MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868133905 ATIVAN 1 MG TABLET 3758 LORAZEPAM PHYSICIANS TC. 54868134100 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PHYSICIANS TC. 54868134101 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PHYSICIANS TC. 54868134102 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PHYSICIANS TC. 54868134400 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 229 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868134402 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL PHYSICIANS TC. 54868134403 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL PHYSICIANS TC. 54868134404 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL PHYSICIANS TC. 54868135200 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL PHYSICIANS TC. 54868135401 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL PHYSICIANS TC. 54868144700 ANAFRANIL 50 MG CAPSULE 46121 CLOMIPRAMINE HCL PHYSICIANS TC. 54868144900 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL PHYSICIANS TC. 54868145000 WELLBUTRIN 100 MG TABLET 46237 BUPROPION HCL PHYSICIANS TC. 54868153400 AMITRIP-CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEPHYSICIANS TC. 54868168901 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PHYSICIANS TC. 54868168902 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PHYSICIANS TC. 54868168903 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PHYSICIANS TC. 54868182800 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL PHYSICIANS TC. 54868182802 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL PHYSICIANS TC. 54868183200 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL PHYSICIANS TC. 54868183202 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL PHYSICIANS TC. 54868183203 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL PHYSICIANS TC. 54868191100 STRATTERA 80 MG CAPSULE 60390 ATOMOXETINE HCL PHYSICIANS TC. 54868195901 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHYSICIANS TC. 54868195902 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHYSICIANS TC. 54868195903 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHYSICIANS TC. 54868195904 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PHYSICIANS TC. 54868196400 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PHYSICIANS TC. 54868196402 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PHYSICIANS TC. 54868196403 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PHYSICIANS TC. 54868212601 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHYSICIANS TC. 54868212602 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHYSICIANS TC. 54868212603 DIAZEPAM 2MG TABLET 3767 DIAZEPAM PHYSICIANS TC. 54868212604 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHYSICIANS TC. 54868212605 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHYSICIANS TC. 54868212606 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PHYSICIANS TC. 54868213300 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868213301 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868213302 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868213303 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868213304 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868214400 ATIVAN 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214500 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214502 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 230 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868214503 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214504 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214505 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214506 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214507 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214508 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868214509 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PHYSICIANS TC. 54868215600 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL PHYSICIANS TC. 54868215601 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL PHYSICIANS TC. 54868218200 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PHYSICIANS TC. 54868218201 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PHYSICIANS TC. 54868218202 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PHYSICIANS TC. 54868219200 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868219201 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868219203 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868219204 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868219205 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868219207 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868219208 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868220600 AMITRIP-CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEPHYSICIANS TC. 54868220601 AMITRIP-CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEPHYSICIANS TC. 54868222100 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL PHYSICIANS TC. 54868222101 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL PHYSICIANS TC. 54868222103 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL PHYSICIANS TC. 54868222104 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL PHYSICIANS TC. 54868222105 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL PHYSICIANS TC. 54868228402 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL PHYSICIANS TC. 54868228404 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL PHYSICIANS TC. 54868228406 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL PHYSICIANS TC. 54868229600 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL PHYSICIANS TC. 54868229602 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL PHYSICIANS TC. 54868230200 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL PHYSICIANS TC. 54868230202 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL PHYSICIANS TC. 54868230300 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL PHYSICIANS TC. 54868230600 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL PHYSICIANS TC. 54868231700 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PHYSICIANS TC. 54868231702 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PHYSICIANS TC. 54868231703 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PHYSICIANS TC. 54868231704 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 231 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868232000 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868232001 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868232002 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868232700 LOXAPINE 10 MG CAPSULE 3981 LOXAPINE SUCCINATE PHYSICIANS TC. 54868234300 THIOTHIXENE 2 MG CAPSULE 3997 THIOTHIXENE PHYSICIANS TC. 54868234700 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL PHYSICIANS TC. 54868235601 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL PHYSICIANS TC. 54868235700 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL PHYSICIANS TC. 54868235702 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL PHYSICIANS TC. 54868235703 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL PHYSICIANS TC. 54868235800 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE PHYSICIANS TC. 54868236100 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868236102 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868236103 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868236104 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868236201 LIBRIUM 100 MG AMPUL 3737 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868237001 FLUPHENAZINE 25MG/ML VIAL 3818 FLUPHENAZINE DECANOATE PHYSICIANS TC. 54868243300 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHYSICIANS TC. 54868243301 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL PHYSICIANS TC. 54868243302 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PHYSICIANS TC. 54868243400 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL PHYSICIANS TC. 54868243402 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL PHYSICIANS TC. 54868246300 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868246301 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL PHYSICIANS TC. 54868246400 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL PHYSICIANS TC. 54868248000 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248001 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248002 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248004 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248101 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248102 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248103 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248200 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL PHYSICIANS TC. 54868248202 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL PHYSICIANS TC. 54868254401 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM PHYSICIANS TC. 54868254403 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM PHYSICIANS TC. 54868254404 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM PHYSICIANS TC. 54868254600 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL PHYSICIANS TC. 54868254900 DESYREL 150 MG TABLET 46243 TRAZODONE HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 232 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868255200 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL PHYSICIANS TC. 54868255700 ESKALITH CR 450 MG TABLET 4005 LITHIUM CARBONATE PHYSICIANS TC. 54868257000 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL PHYSICIANS TC. 54868257001 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL PHYSICIANS TC. 54868257002 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL PHYSICIANS TC. 54868257100 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL PHYSICIANS TC. 54868257101 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL PHYSICIANS TC. 54868263700 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868263701 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868263703 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868263704 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868263705 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868263706 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868263707 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868263708 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868268401 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL PHYSICIANS TC. 54868268500 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868268501 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM PHYSICIANS TC. 54868268600 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE PHYSICIANS TC. 54868268701 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE PHYSICIANS TC. 54868268702 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE PHYSICIANS TC. 54868283301 PAMELOR 10 MG CAPSULE 46059 NORTRIPTYLINE HCL PHYSICIANS TC. 54868283501 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIANS TC. 54868283502 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIANS TC. 54868283503 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIANS TC. 54868283504 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PHYSICIANS TC. 54868288900 HALDOL DECANOATE 50 AMPUL 3966 HALOPERIDOL DECANOATE PHYSICIANS TC. 54868288901 HALDOL DECANOATE 50 AMPUL 3966 HALOPERIDOL DECANOATE PHYSICIANS TC. 54868292900 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868292901 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868292902 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868292903 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868292905 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868292906 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868292907 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868292908 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PHYSICIANS TC. 54868293000 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293001 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293002 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 233 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868293003 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293004 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293005 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293006 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293007 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293009 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PHYSICIANS TC. 54868293200 PRISTIQ ER 50 MG TABLET 63736 DESVENLAFAXINE SUCCINATE PHYSICIANS TC. 54868297600 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIANS TC. 54868297602 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIANS TC. 54868300501 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868300502 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868300503 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868300504 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868300505 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868300506 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868300507 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868300508 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PHYSICIANS TC. 54868303300 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL PHYSICIANS TC. 54868303302 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL PHYSICIANS TC. 54868314600 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL PHYSICIANS TC. 54868331100 SERENTIL 100 MG TABLET 3886 MESORIDAZINE BESYLATE PHYSICIANS TC. 54868341400 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868341401 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868341402 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868341403 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868341404 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868341405 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868345900 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE PHYSICIANS TC. 54868351200 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PHYSICIANS TC. 54868351201 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PHYSICIANS TC. 54868351301 RISPERDAL 2 MG TABLET 21155 RISPERIDONE PHYSICIANS TC. 54868351302 RISPERDAL 2 MG TABLET 21155 RISPERIDONE PHYSICIANS TC. 54868351500 RISPERDAL 4 MG TABLET 21157 RISPERIDONE PHYSICIANS TC. 54868352300 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868352301 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868352302 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868352303 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868352600 PAXIL 30 MG TABLET 46224 PAROXETINE HCL PHYSICIANS TC. 54868353300 DOXEPIN 150 MG CAPSULE 46088 DOXEPIN HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 234 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868353301 DOXEPIN 150 MG CAPSULE 46088 DOXEPIN HCL PHYSICIANS TC. 54868363200 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE PHYSICIANS TC. 54868367000 VALIUM 5 MG/ML AMPUL 3761 DIAZEPAM PHYSICIANS TC. 54868370700 SERZONE 100 MG TABLET 46254 NEFAZODONE HCL PHYSICIANS TC. 54868370800 SERZONE 150 MG TABLET 46255 NEFAZODONE HCL PHYSICIANS TC. 54868389000 DROPERIDOL 2.5 MG/ML AMPUL 3964 DROPERIDOL PHYSICIANS TC. 54868392700 PERPHEN-AMITRIP 4 MG-50 MG TAB 46188 PERPHENAZINE/AMITRIPTYLINE HCLPHYSICIANS TC. 54868394100 ZYPREXA 10 MG TABLET 27960 OLANZAPINE PHYSICIANS TC. 54868396200 PAXIL 40 MG TABLET 46225 PAROXETINE HCL PHYSICIANS TC. 54868398400 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIANS TC. 54868398401 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIANS TC. 54868402300 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL PHYSICIANS TC. 54868402301 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL PHYSICIANS TC. 54868405500 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868405501 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868405502 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868405503 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL PHYSICIANS TC. 54868406100 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PHYSICIANS TC. 54868406500 PAXIL 10 MG TABLET 46222 PAROXETINE HCL PHYSICIANS TC. 54868413400 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PHYSICIANS TC. 54868413401 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PHYSICIANS TC. 54868415900 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868415901 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868415902 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868415903 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868415904 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868421200 BUSPAR 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIANS TC. 54868421201 BUSPAR 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIANS TC. 54868422600 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868422601 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868422602 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868422700 REMERON 15 MG SOLTAB 47453 MIRTAZAPINE PHYSICIANS TC. 54868425200 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHYSICIANS TC. 54868425201 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHYSICIANS TC. 54868425202 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHYSICIANS TC. 54868425203 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHYSICIANS TC. 54868425204 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PHYSICIANS TC. 54868425300 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIANS TC. 54868425301 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 235 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868425302 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIANS TC. 54868425303 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIANS TC. 54868425304 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PHYSICIANS TC. 54868425400 ZYPREXA 5 MG TABLET 27961 OLANZAPINE PHYSICIANS TC. 54868425401 ZYPREXA 5 MG TABLET 27961 OLANZAPINE PHYSICIANS TC. 54868425500 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE PHYSICIANS TC. 54868425501 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE PHYSICIANS TC. 54868425700 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PHYSICIANS TC. 54868425701 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PHYSICIANS TC. 54868425702 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PHYSICIANS TC. 54868425703 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PHYSICIANS TC. 54868425704 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PHYSICIANS TC. 54868427200 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PHYSICIANS TC. 54868427201 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PHYSICIANS TC. 54868428500 VALPROIC ACID 250 MG/5 ML SYR 4535 VALPROATE SODIUM PHYSICIANS TC. 54868437200 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL PHYSICIANS TC. 54868437201 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL PHYSICIANS TC. 54868437202 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL PHYSICIANS TC. 54868439400 PROZAC 40 MG PULVULE 46215 FLUOXETINE HCL PHYSICIANS TC. 54868449200 PROVIGIL 100 MG TABLET 25848 MODAFINIL PHYSICIANS TC. 54868449201 PROVIGIL 100 MG TABLET 25848 MODAFINIL PHYSICIANS TC. 54868449800 REMERON 30 MG TABLET 46451 MIRTAZAPINE PHYSICIANS TC. 54868450400 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL PHYSICIANS TC. 54868450401 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL PHYSICIANS TC. 54868450402 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL PHYSICIANS TC. 54868450500 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL PHYSICIANS TC. 54868450501 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL PHYSICIANS TC. 54868453700 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868453701 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868453702 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868453703 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868453704 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PHYSICIANS TC. 54868454400 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL PHYSICIANS TC. 54868455000 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIANS TC. 54868455001 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIANS TC. 54868455002 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIANS TC. 54868455003 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PHYSICIANS TC. 54868456000 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PHYSICIANS TC. 54868456001 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 236 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868456002 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL PHYSICIANS TC. 54868456200 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL PHYSICIANS TC. 54868456500 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PHYSICIANS TC. 54868456501 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PHYSICIANS TC. 54868456502 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PHYSICIANS TC. 54868456503 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PHYSICIANS TC. 54868456800 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868456801 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868456802 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868456803 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868456804 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868456805 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PHYSICIANS TC. 54868457000 SARAFEM 10 MG PULVULE 46213 FLUOXETINE HCL PHYSICIANS TC. 54868458600 DIAZEPAM 5 MG/ML SYRINGE 3762 DIAZEPAM PHYSICIANS TC. 54868464700 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIANS TC. 54868464701 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIANS TC. 54868464702 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIANS TC. 54868464703 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PHYSICIANS TC. 54868466300 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868466301 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868466302 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868466303 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868466304 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868466305 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868466306 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868466307 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PHYSICIANS TC. 54868467300 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE PHYSICIANS TC. 54868467301 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE PHYSICIANS TC. 54868467500 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE PHYSICIANS TC. 54868467501 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE PHYSICIANS TC. 54868467502 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE PHYSICIANS TC. 54868470000 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868470001 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868470002 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868470003 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868470004 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868470005 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868470006 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868474000 STRATTERA 25 MG CAPSULE 51491 ATOMOXETINE HCL PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 237 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868474100 STRATTERA 40 MG CAPSULE 51492 ATOMOXETINE HCL PHYSICIANS TC. 54868474101 STRATTERA 40 MG CAPSULE 51492 ATOMOXETINE HCL PHYSICIANS TC. 54868476300 WELLBUTRIN SR 200 MG TABLET 50496 BUPROPION HCL PHYSICIANS TC. 54868477500 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868477501 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868477502 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868477503 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868477504 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868479100 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL PHYSICIANS TC. 54868481700 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PHYSICIANS TC. 54868481701 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PHYSICIANS TC. 54868481702 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PHYSICIANS TC. 54868482300 SERZONE 200 MG TABLET 46256 NEFAZODONE HCL PHYSICIANS TC. 54868482301 SERZONE 200 MG TABLET 46256 NEFAZODONE HCL PHYSICIANS TC. 54868484800 REMERON 15 MG TABLET 46450 MIRTAZAPINE PHYSICIANS TC. 54868487400 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE PHYSICIANS TC. 54868488400 STRATTERA 60 MG CAPSULE 51493 ATOMOXETINE HCL PHYSICIANS TC. 54868488900 REMERON 30 MG SOLTAB 47454 MIRTAZAPINE PHYSICIANS TC. 54868489200 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIANS TC. 54868489201 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIANS TC. 54868489202 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIANS TC. 54868489203 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PHYSICIANS TC. 54868489700 PROVIGIL 200 MG TABLET 41478 MODAFINIL PHYSICIANS TC. 54868489701 PROVIGIL 200 MG TABLET 41478 MODAFINIL PHYSICIANS TC. 54868491600 LAMICTAL 200 MG TABLET 22551 LAMOTRIGINE PHYSICIANS TC. 54868491601 LAMICTAL 200 MG TABLET 22551 LAMOTRIGINE PHYSICIANS TC. 54868491602 LAMICTAL 200 MG TABLET 22551 LAMOTRIGINE PHYSICIANS TC. 54868492400 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL PHYSICIANS TC. 54868493500 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL PHYSICIANS TC. 54868493700 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIANS TC. 54868493701 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIANS TC. 54868493702 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIANS TC. 54868493703 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIANS TC. 54868493704 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PHYSICIANS TC. 54868493800 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PHYSICIANS TC. 54868495900 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM PHYSICIANS TC. 54868495901 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM PHYSICIANS TC. 54868496100 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PHYSICIANS TC. 54868496101 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 238 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868496102 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PHYSICIANS TC. 54868496103 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PHYSICIANS TC. 54868496104 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PHYSICIANS TC. 54868498500 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868498501 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868501000 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIANS TC. 54868501001 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIANS TC. 54868508000 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PHYSICIANS TC. 54868517800 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868517801 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868517802 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868517803 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868517804 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868517805 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868519200 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIANS TC. 54868519201 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIANS TC. 54868519202 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIANS TC. 54868519203 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL PHYSICIANS TC. 54868520200 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE PHYSICIANS TC. 54868521500 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL PHYSICIANS TC. 54868521501 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL PHYSICIANS TC. 54868521502 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL PHYSICIANS TC. 54868523901 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE PHYSICIANS TC. 54868527500 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868527501 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868527502 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PHYSICIANS TC. 54868531500 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL PHYSICIANS TC. 54868533600 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE PHYSICIANS TC. 54868534700 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL PHYSICIANS TC. 54868536500 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL PHYSICIANS TC. 54868537700 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL PHYSICIANS TC. 54868537701 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL PHYSICIANS TC. 54868541400 STRATTERA 18 MG CAPSULE 51490 ATOMOXETINE HCL PHYSICIANS TC. 54868544800 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PHYSICIANS TC. 54868548400 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE PHYSICIANS TC. 54868548401 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE PHYSICIANS TC. 54868548500 GEODON 60 MG CAPSULE 47567 ZIPRASIDONE HCL PHYSICIANS TC. 54868551500 ALPRAZOLAM XR 0.5 MG TABLET 50399 ALPRAZOLAM PHYSICIANS TC. 54868552500 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 239 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868552501 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM PHYSICIANS TC. 54868556200 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL PHYSICIANS TC. 54868558100 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE PHYSICIANS TC. 54868558101 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE PHYSICIANS TC. 54868558102 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE PHYSICIANS TC. 54868558103 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE PHYSICIANS TC. 54868560500 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL PHYSICIANS TC. 54868560601 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL PHYSICIANS TC. 54868563800 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563801 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563802 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563803 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563804 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563805 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563806 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563807 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563808 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PHYSICIANS TC. 54868563900 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868563901 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868563902 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868563903 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868563904 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868563905 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868563906 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PHYSICIANS TC. 54868565800 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PHYSICIANS TC. 54868566300 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHYSICIANS TC. 54868566301 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHYSICIANS TC. 54868566302 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PHYSICIANS TC. 54868573600 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL PHYSICIANS TC. 54868573601 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL PHYSICIANS TC. 54868575400 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868575401 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868575402 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868575403 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PHYSICIANS TC. 54868580000 RISPERDAL 1 MG/ML SOLUTION 26177 RISPERIDONE PHYSICIANS TC. 54868581200 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PHYSICIANS TC. 54868585100 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM PHYSICIANS TC. 54868585101 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM PHYSICIANS TC. 54868591800 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE PHYSICIANS TC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 240 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 54868591801 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE PHYSICIANS TC. 54868592102 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE PHYSICIANS TC. 54868592700 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIANS TC. 54868592702 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL PHYSICIANS TC. 54868595100 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868595102 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE PHYSICIANS TC. 54868595500 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE PHYSICIANS TC. 54868595501 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE PHYSICIANS TC. 54868601000 LORAZEPAM INTENSOL 2 MG/ML 16363 LORAZEPAM PHYSICIANS TC. 54868607200 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PHYSICIANS TC. 54868607201 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PHYSICIANS TC. 54868607202 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PHYSICIANS TC. 54868607203 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PHYSICIANS TC. 54868607800 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE PHYSICIANS TC. 54868607801 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE PHYSICIANS TC. 54868607802 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE PHYSICIANS TC. 54868608200 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE PHYSICIANS TC. 54868608201 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE PHYSICIANS TC. 54868608801 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM PHYSICIANS TC. 54868608802 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM PHYSICIANS TC. 54868612700 VENLAFAXINE HCL ER 37.5 MG TAB 64444 VENLAFAXINE HCL PHYSICIANS TC. 54868613900 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PHYSICIANS TC. 54868613901 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PHYSICIANS TC. 54868614000 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL PHYSICIANS TC. 54868614001 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL PHYSICIANS TC. 54868614100 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL PHYSICIANS TC. 54868614101 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL PHYSICIANS TC. 54868617800 PAROXETINE CR 12.5 MG TABLET 50137 PAROXETINE HCL PHYSICIANS TC. 54868620100 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE PHYSICIANS TC. 54868620101 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE PHYSICIANS TC. 54868624300 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE PHYSICIANS TC. 54868624700 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL PHYSICIANS TC. 54868628000 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE PHYSICIANS TC. 55045112308 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DRX 55045117103 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045117104 DIAZEPAM 5MG TABLET 3768 DIAZEPAM DRX 55045117105 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045117107 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045117108 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 241 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55045117109 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045121207 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM DRX 55045121208 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM DRX 55045125508 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM DRX 55045137208 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM DRX 55045143008 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL DRX 55045146301 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DRX 55045146304 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL DRX 55045146307 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DRX 55045146308 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DRX 55045146309 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DRX 55045158808 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL DRX 55045159205 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL DRX 55045159206 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL DRX 55045159208 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL DRX 55045162400 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DRX 55045162404 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DRX 55045162405 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DRX 55045162406 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DRX 55045162408 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DRX 55045163001 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL DRX 55045163008 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL DRX 55045168200 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL DRX 55045168202 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL DRX 55045168205 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL DRX 55045168208 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL DRX 55045171508 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL DRX 55045171509 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL DRX 55045172408 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL DRX 55045172409 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL DRX 55045172608 PAMELOR 25MG CAPSULE 46060 NORTRIPTYLINE HCL DRX 55045174101 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DRX 55045174105 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DRX 55045174106 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DRX 55045174108 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DRX 55045174109 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DRX 55045175301 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE DRX 55045178108 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL DRX 55045183708 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL DRX

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 242 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55045188408 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL DRX 55045195608 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL DRX 55045195609 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL DRX 55045197102 DIAZEPAM 5MG/ML AMPUL 3761 DIAZEPAM DRX 55045203108 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL DRX 55045203208 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL DRX 55045208403 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL DRX 55045208406 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL DRX 55045210201 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DRX 55045210203 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DRX 55045210207 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DRX 55045210208 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DRX 55045211001 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DRX 55045211003 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DRX 55045211006 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DRX 55045211008 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM DRX 55045211009 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DRX 55045213303 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM DRX 55045215301 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL DRX 55045215308 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL DRX 55045219808 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM DRX 55045220801 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL DRX 55045220803 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL DRX 55045220807 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL DRX 55045220808 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL DRX 55045222400 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL DRX 55045222402 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL DRX 55045222407 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL DRX 55045222408 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL DRX 55045227801 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DRX 55045227804 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DRX 55045227806 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DRX 55045227808 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DRX 55045227809 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DRX 55045236008 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL DRX 55045248408 DEPAKOTE 250 MG TABLET EC 4539 DIVALPROEX SODIUM DRX 55045250901 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL DRX 55045250906 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL DRX 55045250908 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL DRX

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 243 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55045256804 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM DRX 55045263108 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL DRX 55045270500 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE DRX 55045287902 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL DRX 55045287906 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL DRX 55045287909 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL DRX 55045290808 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL DRX 55045293400 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE DRX 55045293408 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE DRX 55045298500 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE DRX 55045298508 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE DRX 55045308506 PROVIGIL 200 MG TABLET 41478 MODAFINIL DRX 55045308606 PROVIGIL 100 MG TABLET 25848 MODAFINIL DRX 55045308808 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL DRX 55045317308 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL DRX 55045319501 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL DRX 55045319502 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL DRX 55045319506 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL DRX 55045319508 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL DRX 55045319509 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL DRX 55045319606 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL DRX 55045319608 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL DRX 55045322009 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL DRX 55045327601 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DRX 55045327602 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DRX 55045327606 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DRX 55045327608 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DRX 55045327609 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DRX 55045328402 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045328403 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045328404 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045328409 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DRX 55045328602 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DRX 55045328604 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DRX 55045328605 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DRX 55045328606 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DRX 55045328608 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DRX 55045328609 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DRX 55045329901 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DRX

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 244 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55045329909 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DRX 55045334106 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE DRX 55045336808 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL DRX 55045338608 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL DRX 55045338708 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL DRX 55045342301 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE DRX 55045342302 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE DRX 55045342400 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE DRX 55045356201 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL DRX 55045356601 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL DRX 55045356801 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL DRX 55045375101 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM DRX 55045375608 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DRX 55045375708 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL DRX 55045376608 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL DRX 55045377008 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DRX 55045379901 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL DRX 55111013860 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL DR. REDDY'S LABORATORIES, INC. 55111013960 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL DR. REDDY'S LABORATORIES, INC. 55111014060 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL DR. REDDY'S LABORATORIES, INC. 55111014160 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL DR. REDDY'S LABORATORIES, INC. 55111014260 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL DR. REDDY'S LABORATORIES, INC. 55111014701 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL DR. REDDY'S LABORATORIES, INC. 55111014801 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL DR. REDDY'S LABORATORIES, INC. 55111014810 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL DR. REDDY'S LABORATORIES, INC. 55111014901 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL DR. REDDY'S LABORATORIES, INC. 55111014930 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL DR. REDDY'S LABORATORIES, INC. 55111016901 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111016905 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111017330 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL DR. REDDY'S LABORATORIES, INC. 55111017405 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL DR. REDDY'S LABORATORIES, INC. 55111017430 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL DR. REDDY'S LABORATORIES, INC. 55111017505 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL DR. REDDY'S LABORATORIES, INC. 55111017530 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL DR. REDDY'S LABORATORIES, INC. 55111018601 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111018901 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111019060 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111020105 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020160 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE DR. REDDY'S LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 245 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55111020205 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020260 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020305 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020360 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020405 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020460 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020505 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020560 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020660 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020781 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020881 RISPERIDONE 1 MG ODT 51799 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111020981 RISPERIDONE 2 MG ODT 51800 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111022001 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022005 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022101 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022105 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022205 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022260 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022305 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022360 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022501 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022601 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111022605 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE DR. REDDY'S LABORATORIES, INC. 55111024901 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111024905 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111025660 ZIPRASIDONE HCL 20 MG CAPSULE 47563 ZIPRASIDONE HCL DR. REDDY'S LABORATORIES, INC. 55111025760 ZIPRASIDONE HCL 40 MG CAPSULE 47564 ZIPRASIDONE HCL DR. REDDY'S LABORATORIES, INC. 55111025860 ZIPRASIDONE HCL 60 MG CAPSULE 47567 ZIPRASIDONE HCL DR. REDDY'S LABORATORIES, INC. 55111025960 ZIPRASIDONE HCL 80 MG CAPSULE 47568 ZIPRASIDONE HCL DR. REDDY'S LABORATORIES, INC. 55111026281 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE DR. REDDY'S LABORATORIES, INC. 55111026381 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE DR. REDDY'S LABORATORIES, INC. 55111026481 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE DR. REDDY'S LABORATORIES, INC. 55111026581 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE DR. REDDY'S LABORATORIES, INC. 55111028448 FLUOXETINE DR 90 MG CAPSULE 47571 FLUOXETINE HCL DR. REDDY'S LABORATORIES, INC. 55111034201 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111034205 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111034230 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111034301 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111034305 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 246 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55111034330 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111034401 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111034405 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111034430 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE DR. REDDY'S LABORATORIES, INC. 55111045305 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045330 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045390 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045405 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045430 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045490 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045505 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045530 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111045590 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111047081 RISPERIDONE 3 MG ODT 59402 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111047181 RISPERIDONE 4 MG ODT 59403 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111052901 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM DR. REDDY'S LABORATORIES, INC. 55111053001 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM DR. REDDY'S LABORATORIES, INC. 55111053101 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM DR. REDDY'S LABORATORIES, INC. 55111053201 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM DR. REDDY'S LABORATORIES, INC. 55111053205 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM DR. REDDY'S LABORATORIES, INC. 55111054590 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111054605 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111054690 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111054790 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111054805 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111054890 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111054990 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL DR. REDDY'S LABORATORIES, INC. 55111057930 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE DR. REDDY'S LABORATORIES, INC. 55111060601 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE DR. REDDY'S LABORATORIES, INC. 55111064001 MEPROBAMATE 200 MG TABLET 3713 MEPROBAMATE DR. REDDY'S LABORATORIES, INC. 55111064101 MEPROBAMATE 400 MG TABLET 3714 MEPROBAMATE DR. REDDY'S LABORATORIES, INC. 55175067800 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM CHESHIRE DRUGS 55175067801 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM CHESHIRE DRUGS 55175067802 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM CHESHIRE DRUGS 55175067902 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM CHESHIRE DRUGS 55175067903 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM CHESHIRE DRUGS 55175067904 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM CHESHIRE DRUGS 55175067905 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM CHESHIRE DRUGS 55175068001 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM CHESHIRE DRUGS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 247 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55175068102 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM CHESHIRE DRUGS 55175229603 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL CHESHIRE DRUGS 55175229805 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL CHESHIRE DRUGS 55175229900 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL CHESHIRE DRUGS 55175271403 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL CHESHIRE DRUGS 55175271404 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL CHESHIRE DRUGS 55175271406 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL CHESHIRE DRUGS 55175271503 PAXIL 20MG TABLET 46223 PAROXETINE HCL CHESHIRE DRUGS 55175271608 ZOLOFT 100MG TABLET 46229 SERTRALINE HCL CHESHIRE DRUGS 55175271703 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL CHESHIRE DRUGS 55175271705 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL CHESHIRE DRUGS 55175271706 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL CHESHIRE DRUGS 55175271901 EFFEXOR 37.5MG TABLET 46399 VENLAFAXINE HCL CHESHIRE DRUGS 55175403701 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403702 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403703 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403705 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403707 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403801 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403803 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403806 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403809 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403901 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403902 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403903 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403906 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403907 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175403909 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175404001 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL CHESHIRE DRUGS 55175404107 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL CHESHIRE DRUGS 55175404200 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL CHESHIRE DRUGS 55175404303 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL CHESHIRE DRUGS 55175404306 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL CHESHIRE DRUGS 55175404403 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL CHESHIRE DRUGS 55175404501 WELLBUTRIN 75MG TABLET 46236 BUPROPION HCL CHESHIRE DRUGS 55175419000 DIAZEPAM 10MG TABLET 3766 DIAZEPAM CHESHIRE DRUGS 55175419002 DIAZEPAM 10MG TABLET 3766 DIAZEPAM CHESHIRE DRUGS 55175419100 DIAZEPAM 5MG TABLET 3768 DIAZEPAM CHESHIRE DRUGS 55175419101 DIAZEPAM 5MG TABLET 3768 DIAZEPAM CHESHIRE DRUGS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 248 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55175419102 DIAZEPAM 5MG TABLET 3768 DIAZEPAM CHESHIRE DRUGS 55175419103 DIAZEPAM 5MG TABLET 3768 DIAZEPAM CHESHIRE DRUGS 55175419105 DIAZEPAM 5MG TABLET 3768 DIAZEPAM CHESHIRE DRUGS 55175419106 DIAZEPAM 5MG TABLET 3768 DIAZEPAM CHESHIRE DRUGS 55175419108 DIAZEPAM 5MG TABLET 3768 DIAZEPAM CHESHIRE DRUGS 55175422503 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL CHESHIRE DRUGS 55175422509 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL CHESHIRE DRUGS 55175441303 DIAZEPAM 2MG TABLET 3767 DIAZEPAM CHESHIRE DRUGS 55175500401 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM CHESHIRE DRUGS 55175500501 DIAZEPAM 5MG/ML VIAL 3763 DIAZEPAM CHESHIRE DRUGS 55175500601 DIAZEPAM 5MG/ML SYRINGE 3762 DIAZEPAM CHESHIRE DRUGS 55175532003 LORAZEPAM 1MG TABLET 3758 LORAZEPAM CHESHIRE DRUGS 55175532005 LORAZEPAM 1MG TABLET 3758 LORAZEPAM CHESHIRE DRUGS 55175551503 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL CHESHIRE DRUGS 55175605002 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLCHESHIRE DRUGS 55253080130 MODAFINIL 100 MG TABLET 25848 MODAFINIL CIMA LABS 55253080190 MODAFINIL 100 MG TABLET 25848 MODAFINIL CIMA LABS 55253080230 MODAFINIL 200 MG TABLET 41478 MODAFINIL CIMA LABS 55253080290 MODAFINIL 200 MG TABLET 41478 MODAFINIL CIMA LABS 55289001130 XANAX 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55289001630 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289001660 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289001801 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 55289001830 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 55289002821 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 55289002830 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 55289003621 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 55289003630 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 55289003745 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 55289003790 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 55289005345 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 55289005390 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 55289006014 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 55289006106 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 55289006130 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 55289006160 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 55289006407 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55289006414 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55289006430 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 249 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55289006460 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55289006490 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55289009106 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009109 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009110 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009112 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009115 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009121 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009130 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009160 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009190 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289009201 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009202 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009206 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009210 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009217 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009220 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009225 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009230 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009240 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009260 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009290 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009298 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55289009930 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 55289009950 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 55289011706 VALIUM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289011712 VALIUM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289011720 VALIUM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55289012412 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289012430 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289014414 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 55289014430 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 55289014490 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 55289014930 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL LABELER NOT ON FILE 55289014960 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL LABELER NOT ON FILE 55289018517 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLLABELER NOT ON FILE 55289018730 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 55289019840 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 55289020840 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 250 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55289021330 ZYPREXA 10 MG TABLET 27960 OLANZAPINE LABELER NOT ON FILE 55289021522 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55289021630 PAXIL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55289022330 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 55289022360 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 55289022390 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 55289025130 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE LABELER NOT ON FILE 55289025330 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 55289025830 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL LABELER NOT ON FILE 55289027730 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 55289029114 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55289029130 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55289029160 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55289030814 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55289030821 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55289030828 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55289030830 PROZAC 10 MG PULVULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55289034130 ST. JOHN'S WORT 300 MG TAB 46337 ST. JOHN'S WORT LABELER NOT ON FILE 55289034530 XANAX 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55289034610 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289034620 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289034630 XANAX 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289037030 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 55289037830 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 55289038130 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55289038145 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55289038160 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55289038190 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55289040230 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 55289040290 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 55289040430 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 55289040930 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55289040960 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55289041030 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 55289044730 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 55289046330 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE LABELER NOT ON FILE 55289046530 RISPERDAL 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 55289048702 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048704 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 251 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55289048709 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048715 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048720 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048730 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048760 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048779 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048790 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048798 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55289048930 DESYREL 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 55289049130 RISPERDAL 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 55289049930 ZYPREXA 20 MG TABLET 41027 OLANZAPINE LABELER NOT ON FILE 55289050814 LIMBITROL TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDELABELER NOT ON FILE 55289051930 RISPERDAL 4 MG TABLET 21157 RISPERIDONE LABELER NOT ON FILE 55289052301 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 55289052330 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 55289052340 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 55289052360 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 55289052390 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 55289055015 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55289055030 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55289055630 BUSPAR 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 55289056630 ABILIFY 30 MG TABLET 51336 ARIPIPRAZOLE LABELER NOT ON FILE 55289058630 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 55289059401 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 55289059430 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 55289059460 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 55289059490 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 55289061014 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55289061028 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55289061030 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55289061060 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55289061090 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55289061314 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55289061330 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55289061360 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55289073001 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289073012 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289073025 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289073030 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 252 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55289073060 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289073090 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55289073330 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 55289073360 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 55289076830 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 55289082730 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55289082830 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 55289083030 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 55289083930 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 55289086030 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 55289086930 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 55289087230 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 55289088314 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55289088330 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55289088360 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55289088390 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55289089730 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 55289090015 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 55289090030 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 55289090530 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 55289092006 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55289092030 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55289092040 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55289092060 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55289092090 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55289092098 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55289092215 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 55289092230 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 55289094515 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55289094530 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55289094560 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55289094590 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55289094598 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55289096205 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289096220 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289096230 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289096260 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289096290 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55289096298 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 253 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55289097230 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55289097260 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55289097290 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55289097920 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 55289097930 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 55289097960 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 55289098330 MEPROBAMATE 400 MG TABLET 3714 MEPROBAMATE LABELER NOT ON FILE 55289099130 DEPAKOTE 125 MG SPRINKLE CAP 4537 DIVALPROEX SODIUM LABELER NOT ON FILE 55370053007 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL STADA PHARMACEUTICALS, INC. 55370053107 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL STADA PHARMACEUTICALS, INC. 55370053207 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL STADA PHARMACEUTICALS, INC. 55370080207 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL STADA PHARMACEUTICALS, INC. 55370080307 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL STADA PHARMACEUTICALS, INC. 55370080407 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL STADA PHARMACEUTICALS, INC. 55370080507 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL STADA PHARMACEUTICALS, INC. 55370080607 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL STADA PHARMACEUTICALS, INC. 55390000710 VALPROATE SOD 500 MG/5 ML VL 31533 VALPROATE SODIUM BEDFORD LABORATORIES 55390014701 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE BEDFORD LABORATORIES 55390014710 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE BEDFORD LABORATORIES 55390041201 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390041205 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390041301 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390041305 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390042201 HALOPERIDOL DEC 50 MG/ML VL 3967 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390042205 HALOPERIDOL DEC 50 MG/ML VL 3967 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390042301 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390042305 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE BEDFORD LABORATORIES 55390044701 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE BEDFORD LABORATORIES 55390044710 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE BEDFORD LABORATORIES 55390046505 FLUPHENAZINE DEC 25 MG/ML VL 3818 FLUPHENAZINE DECANOATE BEDFORD LABORATORIES 55496100109 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 55496100209 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55496100309 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55496100409 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 55496300109 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL LABELER NOT ON FILE 55496300209 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL LABELER NOT ON FILE 55496300309 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL LABELER NOT ON FILE 55496300409 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL LABELER NOT ON FILE 55806034003 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM EFFCON LABORATORIES INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 254 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55806034004 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM EFFCON LABORATORIES INC. 55806034103 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM EFFCON LABORATORIES INC. 55806034104 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM EFFCON LABORATORIES INC. 55806034203 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM EFFCON LABORATORIES INC. 55806034204 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM EFFCON LABORATORIES INC. 55829050110 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL AURO PHARMACEUTICALS INC 55887007530 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 55887009530 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 55887009560 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 55887009590 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 55887010130 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 55887010160 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 55887010190 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 55887012530 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 55887015860 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 55887019330 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 55887019360 EFFEXOR XR 150 MG CAPSULE SA 46405 VENLAFAXINE HCL LABELER NOT ON FILE 55887019390 EFFEXOR XR 150 MG CAPSULE SA 46405 VENLAFAXINE HCL LABELER NOT ON FILE 55887020530 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL LABELER NOT ON FILE 55887020560 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL LABELER NOT ON FILE 55887020590 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL LABELER NOT ON FILE 55887021330 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL LABELER NOT ON FILE 55887021430 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL LABELER NOT ON FILE 55887024530 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55887024560 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55887024582 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55887024590 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 55887025030 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55887025060 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55887025082 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55887025090 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 55887025630 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 55887025660 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 55887025690 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 55887026030 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887026107 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887026130 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887027015 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 55887027030 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 255 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55887027060 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 55887027090 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 55887027115 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 55887027130 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 55887027160 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 55887027190 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 55887027530 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE LABELER NOT ON FILE 55887028020 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55887028030 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55887028060 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55887028090 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 55887028330 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 55887028360 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 55887028390 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 55887028430 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 55887028460 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 55887028490 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 55887028982 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 55887034630 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 55887034660 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 55887039430 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55887039460 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55887039830 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887040960 BUPROPION HCL ER 100 MG TAB 46239 BUPROPION HCL LABELER NOT ON FILE 55887044530 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 55887044560 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 55887044582 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 55887044590 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 55887045830 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55887045840 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 55887048630 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 55887048660 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 55887048682 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 55887048690 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 55887048730 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55887048760 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55887048782 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55887048790 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 55887049430 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 256 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55887049460 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 55887049482 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 55887049490 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 55887049660 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 55887050230 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887051860 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 55887051920 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 55887051930 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 55887051960 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 55887051990 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 55887052220 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55887052230 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55887052250 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55887052260 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55887052282 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55887052290 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 55887052420 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55887052430 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55887052460 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55887052482 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55887052490 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 55887054130 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 55887054160 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 55887054182 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 55887054190 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 55887054830 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 55887054860 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 55887054930 PAXIL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55887054960 PAXIL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 55887055020 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887055030 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887055060 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887055090 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 55887055220 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887055230 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887055260 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887055282 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887055290 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887057020 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 257 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55887057030 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887057060 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887057090 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887057220 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887057230 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887057250 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887057260 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 55887063330 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 55887063360 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 55887063390 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 55887064820 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55887064821 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55887064830 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55887064860 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 55887065030 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 55887065060 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 55887066030 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 55887066060 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 55887066082 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 55887066090 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 55887066101 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55887066130 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55887066430 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL LABELER NOT ON FILE 55887066490 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL LABELER NOT ON FILE 55887066530 EFFEXOR XR 75 MG CAPSULE SA 46404 VENLAFAXINE HCL LABELER NOT ON FILE 55887066560 EFFEXOR XR 75 MG CAPSULE SA 46404 VENLAFAXINE HCL LABELER NOT ON FILE 55887066582 EFFEXOR XR 75 MG CAPSULE SA 46404 VENLAFAXINE HCL LABELER NOT ON FILE 55887066590 EFFEXOR XR 75 MG CAPSULE SA 46404 VENLAFAXINE HCL LABELER NOT ON FILE 55887068610 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55887068620 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55887068630 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55887068660 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55887068682 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55887068690 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 55887087160 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 55887092560 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55887092582 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55887092590 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55887094707 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 258 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 55887094730 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 55887094830 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 55887094860 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 55887094890 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 55887096715 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55887096730 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55887096760 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55887096790 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 55953003140 CLOMIPRAMINE 25MG CAPSULE 46120 CLOMIPRAMINE HCL NOVOPHARM USA, INC. 55953003170 CLOMIPRAMINE 25MG CAPSULE 46120 CLOMIPRAMINE HCL NOVOPHARM USA, INC. 55953003240 CLOMIPRAMINE 50MG CAPSULE 46121 CLOMIPRAMINE HCL NOVOPHARM USA, INC. 55953003270 CLOMIPRAMINE 50MG CAPSULE 46121 CLOMIPRAMINE HCL NOVOPHARM USA, INC. 55953003340 CLOMIPRAMINE 75MG CAPSULE 46122 CLOMIPRAMINE HCL NOVOPHARM USA, INC. 55953012640 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM NOVOPHARM USA, INC. 55953012670 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM NOVOPHARM USA, INC. 55953012680 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM NOVOPHARM USA, INC. 55953012740 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM NOVOPHARM USA, INC. 55953012770 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM NOVOPHARM USA, INC. 55953012780 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM NOVOPHARM USA, INC. 55953013140 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM NOVOPHARM USA, INC. 55953013170 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM NOVOPHARM USA, INC. 55953013180 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM NOVOPHARM USA, INC. 55953086840 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM NOVOPHARM USA, INC. 55953086870 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM NOVOPHARM USA, INC. 55953088040 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM NOVOPHARM USA, INC. 55953088070 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM NOVOPHARM USA, INC. 55953089140 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM NOVOPHARM USA, INC. 55953089170 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM NOVOPHARM USA, INC. 55953098140 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM NOVOPHARM USA, INC. 55953098170 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM NOVOPHARM USA, INC. 55953098240 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM NOVOPHARM USA, INC. 55953098270 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM NOVOPHARM USA, INC. 55953098340 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM NOVOPHARM USA, INC. 56126005411 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL UNITED STATES TRADING CORPORATION 56126005511 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL UNITED STATES TRADING CORPORATION 56126005611 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL UNITED STATES TRADING CORPORATION 56126009611 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL UNITED STATES TRADING CORPORATION 56126009711 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL UNITED STATES TRADING CORPORATION 56126009811 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL UNITED STATES TRADING CORPORATION

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 259 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 56126009911 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL UNITED STATES TRADING CORPORATION 56126010111 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL UNITED STATES TRADING CORPORATION 56126010611 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID UNITED STATES TRADING CORPORATION 56126013311 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL UNITED STATES TRADING CORPORATION 56126013511 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL UNITED STATES TRADING CORPORATION 56126013711 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL UNITED STATES TRADING CORPORATION 56126018211 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLUNITED STATES TRADING CORPORATION 56126018311 AMITRIP/PERPHEN 10-4 TABLET 46185 PERPHENAZINE/AMITRIPTYLINE HCLUNITED STATES TRADING CORPORATION 56126018411 AMITRIP/PERPHEN 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLUNITED STATES TRADING CORPORATION 56126018511 AMITRIP/PERPHEN 50-4 TABLET 46188 PERPHENAZINE/AMITRIPTYLINE HCLUNITED STATES TRADING CORPORATION 56126031011 THIORIDAZINE 150MG TABLET 3862 THIORIDAZINE HCL UNITED STATES TRADING CORPORATION 56126031111 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL UNITED STATES TRADING CORPORATION 56126033511 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL UNITED STATES TRADING CORPORATION 56126033611 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL UNITED STATES TRADING CORPORATION 56126033711 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL UNITED STATES TRADING CORPORATION 56126034511 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL UNITED STATES TRADING CORPORATION 56126034611 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL UNITED STATES TRADING CORPORATION 56126034711 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL UNITED STATES TRADING CORPORATION 56126034811 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL UNITED STATES TRADING CORPORATION 56126034911 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL UNITED STATES TRADING CORPORATION 56126036811 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL UNITED STATES TRADING CORPORATION 56126036911 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL UNITED STATES TRADING CORPORATION 56126037611 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL UNITED STATES TRADING CORPORATION 56126037711 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL UNITED STATES TRADING CORPORATION 56126037811 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE UNITED STATES TRADING CORPORATION 56126037911 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE UNITED STATES TRADING CORPORATION 56126038011 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE UNITED STATES TRADING CORPORATION 56126038111 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE UNITED STATES TRADING CORPORATION 56126040111 DOXEPIN 150MG CAPSULE 46088 DOXEPIN HCL UNITED STATES TRADING CORPORATION 57480030101 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL MEDIREX INC 57480030106 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL MEDIREX INC 57480030201 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL MEDIREX INC 57480030206 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL MEDIREX INC 57480030301 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MEDIREX INC 57480030306 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL MEDIREX INC 57480030401 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL MEDIREX INC 57480031801 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MEDIREX INC 57480031806 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL MEDIREX INC 57480031901 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MEDIREX INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 260 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 57480031906 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL MEDIREX INC 57480032006 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL MEDIREX INC 57480036201 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MEDIREX INC 57480036206 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL MEDIREX INC 57480036301 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MEDIREX INC 57480036306 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL MEDIREX INC 57480036401 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MEDIREX INC 57480036406 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL MEDIREX INC 57480036901 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MEDIREX INC 57480036906 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL MEDIREX INC 57480037001 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MEDIREX INC 57480037006 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL MEDIREX INC 57480037601 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MEDIREX INC 57480037606 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL MEDIREX INC 57480037701 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL MEDIREX INC 57480037801 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MEDIREX INC 57480037806 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL MEDIREX INC 57480037901 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MEDIREX INC 57480037906 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL MEDIREX INC 57480040301 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL MEDIREX INC 57480040306 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL MEDIREX INC 57480040401 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MEDIREX INC 57480040406 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL MEDIREX INC 57480040501 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MEDIREX INC 57480040506 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL MEDIREX INC 57480042401 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL MEDIREX INC 57480042406 AMITRIPTYLINE 100MG TABLET 46044 AMITRIPTYLINE HCL MEDIREX INC 57480042501 AMITRIPTYLINE HCL 150MG TAB 46045 AMITRIPTYLINE HCL MEDIREX INC 57480042506 AMITRIPTYLINE 150MG TABLET 46045 AMITRIPTYLINE HCL MEDIREX INC 57480044201 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MEDIREX INC 57480044206 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE MEDIREX INC 57480044301 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MEDIREX INC 57480044306 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE MEDIREX INC 57480044401 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MEDIREX INC 57480044406 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE MEDIREX INC 57480046401 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MEDIREX INC 57480046406 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MEDIREX INC 57480048001 AMOXAPINE 25MG TABLET 46083 AMOXAPINE MEDIREX INC 57480048101 AMOXAPINE 50MG TABLET 46084 AMOXAPINE MEDIREX INC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 261 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 57480048401 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID MEDIREX INC 57480049301 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL MEDIREX INC 57480049306 MAPROTILINE 25MG TABLET 46132 MAPROTILINE HCL MEDIREX INC 57480049401 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL MEDIREX INC 57480049406 MAPROTILINE 50MG TABLET 46133 MAPROTILINE HCL MEDIREX INC 57480051501 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MEDIREX INC 57480051506 DIAZEPAM 2MG TABLET 3767 DIAZEPAM MEDIREX INC 57480051601 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MEDIREX INC 57480051606 DIAZEPAM 5MG TABLET 3768 DIAZEPAM MEDIREX INC 57480051701 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MEDIREX INC 57480051706 DIAZEPAM 10MG TABLET 3766 DIAZEPAM MEDIREX INC 57480052001 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM MEDIREX INC 57480052006 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM MEDIREX INC 57480052101 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM MEDIREX INC 57480052106 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM MEDIREX INC 57480052201 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM MEDIREX INC 57480052206 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM MEDIREX INC 57480082401 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL MEDIREX INC 57480082406 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL MEDIREX INC 57480082501 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL MEDIREX INC 57480082506 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL MEDIREX INC 57480082601 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL MEDIREX INC 57664024188 CLOZAPINE 50 MG TABLET 27037 CLOZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664034513 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664034588 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664034713 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664034788 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664035788 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE CARACO PHARMACEUTICAL LABORATORIES LTD 57664036113 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE CARACO PHARMACEUTICAL LABORATORIES LTD 57664036188 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE CARACO PHARMACEUTICAL LABORATORIES LTD 57664036213 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE CARACO PHARMACEUTICAL LABORATORIES LTD 57664036288 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE CARACO PHARMACEUTICAL LABORATORIES LTD 57664042113 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042183 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042199 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042213 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042218 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042283 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042299 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 262 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 57664042413 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042483 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042499 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042513 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042583 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664042599 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL CARACO PHARMACEUTICAL LABORATORIES LTD 57664049918 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664049983 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050018 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050083 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050118 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050183 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050713 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050718 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050783 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050788 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050813 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050818 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050883 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050888 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050913 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050918 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050983 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664050988 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CARACO PHARMACEUTICAL LABORATORIES LTD 57664051018 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57664051083 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE CARACO PHARMACEUTICAL LABORATORIES LTD 57844015101 ORAP 1 MG TABLET 19448 PIMOZIDE GATE PHARMACEUTICALS 57844018701 ORAP 2 MG TABLET 3892 PIMOZIDE GATE PHARMACEUTICALS 57866004508 PAXIL 20 MG TABLET 46223 PAROXETINE HCL DIRECT DISPENSE 57866090102 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL DIRECT DISPENSE 57866091901 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL DIRECT DISPENSE 57866091902 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL DIRECT DISPENSE 57866091903 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL DIRECT DISPENSE 57866092001 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL DIRECT DISPENSE 57866092002 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL DIRECT DISPENSE 57866092003 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL DIRECT DISPENSE 57866092201 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL DIRECT DISPENSE 57866092202 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL DIRECT DISPENSE 57866092203 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL DIRECT DISPENSE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 263 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 57866103501 WELLBUTRIN 75 MG TABLET 46236 BUPROPION HCL DIRECT DISPENSE 57866104201 THIORIDAZINE 10 MG TABLET 3859 THIORIDAZINE HCL DIRECT DISPENSE 57866107302 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL DIRECT DISPENSE 57866109202 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL DIRECT DISPENSE 57866109203 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL DIRECT DISPENSE 57866306102 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE DIRECT DISPENSE 57866307101 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL DIRECT DISPENSE 57866307201 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DIRECT DISPENSE 57866307202 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DIRECT DISPENSE 57866307203 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DIRECT DISPENSE 57866307210 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DIRECT DISPENSE 57866307301 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DIRECT DISPENSE 57866307302 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DIRECT DISPENSE 57866307303 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL DIRECT DISPENSE 57866308305 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL DIRECT DISPENSE 57866348701 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL DIRECT DISPENSE 57866348702 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL DIRECT DISPENSE 57866348801 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL DIRECT DISPENSE 57866348803 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL DIRECT DISPENSE 57866359101 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM DIRECT DISPENSE 57866359102 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM DIRECT DISPENSE 57866359103 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM DIRECT DISPENSE 57866359104 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM DIRECT DISPENSE 57866359201 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359202 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359203 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359204 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359205 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359206 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359207 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359208 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM DIRECT DISPENSE 57866359301 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DIRECT DISPENSE 57866359302 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DIRECT DISPENSE 57866359303 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DIRECT DISPENSE 57866359304 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DIRECT DISPENSE 57866359305 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DIRECT DISPENSE 57866359307 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM DIRECT DISPENSE 57866387801 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL DIRECT DISPENSE 57866387901 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL DIRECT DISPENSE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 264 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 57866388001 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL DIRECT DISPENSE 57866388002 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL DIRECT DISPENSE 57866388101 HALOPERIDOL 20 MG TABLET 3976 HALOPERIDOL DIRECT DISPENSE 57866389701 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE DIRECT DISPENSE 57866390601 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL DIRECT DISPENSE 57866390701 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL DIRECT DISPENSE 57866391001 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL DIRECT DISPENSE 57866391101 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL DIRECT DISPENSE 57866393001 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL DIRECT DISPENSE 57866393101 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL DIRECT DISPENSE 57866395901 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM DIRECT DISPENSE 57866395902 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM DIRECT DISPENSE 57866395903 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM DIRECT DISPENSE 57866395904 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM DIRECT DISPENSE 57866396001 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DIRECT DISPENSE 57866396002 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DIRECT DISPENSE 57866396003 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DIRECT DISPENSE 57866396004 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DIRECT DISPENSE 57866396005 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM DIRECT DISPENSE 57866396101 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM DIRECT DISPENSE 57866396102 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM DIRECT DISPENSE 57866413201 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE DIRECT DISPENSE 57866413202 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE DIRECT DISPENSE 57866413203 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE DIRECT DISPENSE 57866413301 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE DIRECT DISPENSE 57866413302 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE DIRECT DISPENSE 57866413303 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE DIRECT DISPENSE 57866440501 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL DIRECT DISPENSE 57866440502 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL DIRECT DISPENSE 57866440503 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL DIRECT DISPENSE 57866440504 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL DIRECT DISPENSE 57866440601 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL DIRECT DISPENSE 57866440602 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL DIRECT DISPENSE 57866440603 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL DIRECT DISPENSE 57866440604 FLUPHENAZINE 1 MG TABLET 3823 FLUPHENAZINE HCL DIRECT DISPENSE 57866440701 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL DIRECT DISPENSE 57866440702 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL DIRECT DISPENSE 57866440703 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL DIRECT DISPENSE 57866440704 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL DIRECT DISPENSE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 265 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 57866440801 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL DIRECT DISPENSE 57866440802 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL DIRECT DISPENSE 57866440803 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL DIRECT DISPENSE 57866440804 FLUPHENAZINE 10 MG TABLET 3824 FLUPHENAZINE HCL DIRECT DISPENSE 57866442201 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL DIRECT DISPENSE 57866443701 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE DIRECT DISPENSE 57866443702 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE DIRECT DISPENSE 57866443703 THIOTHIXENE 5 MG CAPSULE 3999 THIOTHIXENE DIRECT DISPENSE 57866443801 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE DIRECT DISPENSE 57866443802 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE DIRECT DISPENSE 57866443803 THIOTHIXENE 10 MG CAPSULE 3996 THIOTHIXENE DIRECT DISPENSE 57866443901 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL DIRECT DISPENSE 57866443902 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL DIRECT DISPENSE 57866443903 TRIFLUOPERAZINE 10 MG TABLET 3852 TRIFLUOPERAZINE HCL DIRECT DISPENSE 57866447701 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID DIRECT DISPENSE 57866456401 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL DIRECT DISPENSE 57866456501 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL DIRECT DISPENSE 57866456502 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL DIRECT DISPENSE 57866456503 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL DIRECT DISPENSE 57866456504 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL DIRECT DISPENSE 57866456601 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL DIRECT DISPENSE 57866458801 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL DIRECT DISPENSE 57866463401 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DIRECT DISPENSE 57866463402 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DIRECT DISPENSE 57866463403 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DIRECT DISPENSE 57866463406 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DIRECT DISPENSE 57866463501 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DIRECT DISPENSE 57866463502 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DIRECT DISPENSE 57866463503 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DIRECT DISPENSE 57866463504 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DIRECT DISPENSE 57866463601 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DIRECT DISPENSE 57866463602 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DIRECT DISPENSE 57866463603 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DIRECT DISPENSE 57866463604 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DIRECT DISPENSE 57866464203 THIORIDAZINE 25 MG TABLET 3864 THIORIDAZINE HCL DIRECT DISPENSE 57866464301 THIORIDAZINE 50 MG TABLET 3865 THIORIDAZINE HCL DIRECT DISPENSE 57866464401 THIORIDAZINE 100 MG TABLET 3860 THIORIDAZINE HCL DIRECT DISPENSE 57866468801 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL DIRECT DISPENSE 57866468802 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL DIRECT DISPENSE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 266 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 57866468803 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL DIRECT DISPENSE 57866468804 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL DIRECT DISPENSE 57866471501 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL DIRECT DISPENSE 57866471502 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL DIRECT DISPENSE 57866471503 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL DIRECT DISPENSE 57866471504 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL DIRECT DISPENSE 57866494001 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM DIRECT DISPENSE 57866494002 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM DIRECT DISPENSE 57866494101 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM DIRECT DISPENSE 57866561402 PAXIL 20 MG TABLET 46223 PAROXETINE HCL DIRECT DISPENSE 57866630401 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL DIRECT DISPENSE 57866630500 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL DIRECT DISPENSE 57866630501 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL DIRECT DISPENSE 57866639102 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM DIRECT DISPENSE 57866652301 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE DIRECT DISPENSE 57866652302 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE DIRECT DISPENSE 57866652304 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE DIRECT DISPENSE 57866652305 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE DIRECT DISPENSE 57866665001 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL DIRECT DISPENSE 57866665002 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL DIRECT DISPENSE 57866665003 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL DIRECT DISPENSE 57866697000 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM DIRECT DISPENSE 57866697101 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM DIRECT DISPENSE 57866697102 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM DIRECT DISPENSE 57866697103 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM DIRECT DISPENSE 57866697201 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM DIRECT DISPENSE 57866900001 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DIRECT DISPENSE 57866900002 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL DIRECT DISPENSE 57866910101 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL DIRECT DISPENSE 57866910102 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL DIRECT DISPENSE 57866931701 PROVIGIL 100 MG TABLET 25848 MODAFINIL DIRECT DISPENSE 57866931702 PROVIGIL 100 MG TABLET 25848 MODAFINIL DIRECT DISPENSE 57866931801 PROVIGIL 200 MG TABLET 41478 MODAFINIL DIRECT DISPENSE 57866931802 PROVIGIL 200 MG TABLET 41478 MODAFINIL DIRECT DISPENSE 57866980301 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE DIRECT DISPENSE 58016000400 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016000430 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016000460 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016000490 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 267 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016000900 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016000930 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016000960 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016000990 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016001000 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016001030 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016001060 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016001090 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016001100 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016001130 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016001160 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016001190 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016002400 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016002430 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016002460 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016002490 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016002700 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016002760 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016002790 LEXAPRO 5 MG TABLET 51642 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016002900 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016002930 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016002960 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016002990 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016003000 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016003030 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016003060 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016003090 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016003100 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL SOUTHWOOD PHARM 58016003130 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL SOUTHWOOD PHARM 58016003160 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL SOUTHWOOD PHARM 58016003190 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL SOUTHWOOD PHARM 58016003300 XANAX 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016003330 XANAX 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016003360 XANAX 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016003390 XANAX 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016004600 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE SOUTHWOOD PHARM 58016004630 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE SOUTHWOOD PHARM 58016004660 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE SOUTHWOOD PHARM 58016004690 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 268 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016004900 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE SOUTHWOOD PHARM 58016004930 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE SOUTHWOOD PHARM 58016004960 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE SOUTHWOOD PHARM 58016004990 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE SOUTHWOOD PHARM 58016005000 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE SOUTHWOOD PHARM 58016005030 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE SOUTHWOOD PHARM 58016005060 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE SOUTHWOOD PHARM 58016005090 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE SOUTHWOOD PHARM 58016005400 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE SOUTHWOOD PHARM 58016005430 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE SOUTHWOOD PHARM 58016005460 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE SOUTHWOOD PHARM 58016005490 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE SOUTHWOOD PHARM 58016006400 LIBRIUM 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016006430 LIBRIUM 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016006460 LIBRIUM 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016006490 LIBRIUM 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016008500 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID SOUTHWOOD PHARM 58016008530 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID SOUTHWOOD PHARM 58016008560 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID SOUTHWOOD PHARM 58016008590 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID SOUTHWOOD PHARM 58016009900 XANAX 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016009930 XANAX 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016009960 XANAX 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016009990 XANAX 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016017800 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017802 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017804 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017805 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017810 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017812 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017814 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017815 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017820 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017830 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017840 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017850 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017860 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017889 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016017890 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 269 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016017899 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016019100 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016019115 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016019128 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016019130 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016019150 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016019160 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016019700 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019702 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019703 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019706 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019709 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019710 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019712 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019714 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019715 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019718 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019720 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019724 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019730 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019750 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019760 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019773 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019789 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019790 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016019800 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019802 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019803 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019812 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019815 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019820 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019830 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019860 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019873 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016019889 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM SOUTHWOOD PHARM 58016022000 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016022030 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016022060 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016022090 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 270 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016022400 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022402 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022404 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022405 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022410 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022412 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022414 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022415 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022420 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022430 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022440 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022450 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022460 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022489 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022490 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016022499 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016023100 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE SOUTHWOOD PHARM 58016023150 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE SOUTHWOOD PHARM 58016023160 MEPROBAMATE 400MG TABLET 3714 MEPROBAMATE SOUTHWOOD PHARM 58016024000 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SOUTHWOOD PHARM 58016024002 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SOUTHWOOD PHARM 58016024003 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SOUTHWOOD PHARM 58016024030 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SOUTHWOOD PHARM 58016024060 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SOUTHWOOD PHARM 58016024090 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL SOUTHWOOD PHARM 58016026300 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026302 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026303 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026310 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026312 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026315 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026320 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026328 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026330 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026340 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026360 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026373 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026389 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM 58016026390 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 271 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016027300 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027302 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027303 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027304 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027306 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027309 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027310 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027312 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027315 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027320 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027330 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027340 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027360 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027373 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027389 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027390 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM SOUTHWOOD PHARM 58016027400 DIAZEPAM 2MG TABLET 3767 DIAZEPAM SOUTHWOOD PHARM 58016027412 DIAZEPAM 2MG TABLET 3767 DIAZEPAM SOUTHWOOD PHARM 58016027415 DIAZEPAM 2MG TABLET 3767 DIAZEPAM SOUTHWOOD PHARM 58016027420 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM SOUTHWOOD PHARM 58016027430 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM SOUTHWOOD PHARM 58016027500 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027502 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027503 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027504 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027506 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027508 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027509 DIAZEPAM 5MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027510 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027512 DIAZEPAM 5MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027514 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027515 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027516 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027518 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027520 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027521 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027524 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027528 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027530 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 272 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016027536 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027540 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027550 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027560 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027573 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027589 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016027590 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM SOUTHWOOD PHARM 58016028200 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016028230 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016028260 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016028290 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016031212 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL SOUTHWOOD PHARM 58016032300 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032310 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032314 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032315 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032320 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032321 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032328 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032330 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032340 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032350 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032360 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016032390 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034900 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034910 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034914 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034915 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034920 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034921 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034930 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034940 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034950 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034960 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016034990 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035000 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035010 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035014 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035015 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 273 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016035020 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035021 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035028 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035030 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035040 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035050 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035060 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035090 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035100 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035110 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035114 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035115 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035120 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035121 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035128 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035130 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035140 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035150 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035160 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035190 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035200 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035210 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035214 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035215 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035220 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035221 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035228 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035230 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035240 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035250 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035260 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016035290 EFFEXOR 100 MG TABLET 46402 VENLAFAXINE HCL SOUTHWOOD PHARM 58016036600 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016036630 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016036660 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016036690 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL SOUTHWOOD PHARM 58016037210 TRAZODONE 50MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016037212 TRAZODONE 50MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016037215 TRAZODONE 50MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 274 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016037228 TRAZODONE 50MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016037900 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037902 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037903 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037910 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037912 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037914 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037915 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037920 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037921 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037924 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037925 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037928 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037930 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037940 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037960 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037973 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037989 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016037990 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM SOUTHWOOD PHARM 58016048500 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048502 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048510 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048512 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048515 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048520 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048525 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048530 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048540 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048550 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048560 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048570 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048580 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016048590 PAXIL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016049100 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016049115 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016049120 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016049130 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016049160 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016049170 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 275 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016049190 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016050200 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL SOUTHWOOD PHARM 58016050215 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL SOUTHWOOD PHARM 58016050228 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL SOUTHWOOD PHARM 58016050230 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL SOUTHWOOD PHARM 58016050250 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL SOUTHWOOD PHARM 58016050260 DESIPRAMINE 10 MG TABLET 46103 DESIPRAMINE HCL SOUTHWOOD PHARM 58016050800 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016050815 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016050830 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016050860 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051630 SERZONE 250 MG TABLET 46257 NEFAZODONE HCL SOUTHWOOD PHARM 58016051660 SERZONE 250 MG TABLET 46257 NEFAZODONE HCL SOUTHWOOD PHARM 58016051900 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051912 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051915 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051920 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051930 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051960 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051970 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016051999 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016054600 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL SOUTHWOOD PHARM 58016058400 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058402 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058403 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058410 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058412 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058415 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058420 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058425 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058430 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058440 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058450 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058460 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058470 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058473 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058480 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058489 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM 58016058490 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 276 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016058600 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL SOUTHWOOD PHARM 58016058620 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL SOUTHWOOD PHARM 58016058628 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL SOUTHWOOD PHARM 58016058630 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL SOUTHWOOD PHARM 58016058660 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL SOUTHWOOD PHARM 58016059300 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059330 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059360 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059390 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059800 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059830 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059860 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059890 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE SOUTHWOOD PHARM 58016059900 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016059930 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016059960 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016059990 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016060000 REMERON 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016060030 REMERON 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016060060 REMERON 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016060090 REMERON 45 MG TABLET 46452 MIRTAZAPINE SOUTHWOOD PHARM 58016061500 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL SOUTHWOOD PHARM 58016061530 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL SOUTHWOOD PHARM 58016061560 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL SOUTHWOOD PHARM 58016061590 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL SOUTHWOOD PHARM 58016061600 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL SOUTHWOOD PHARM 58016061630 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL SOUTHWOOD PHARM 58016061660 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL SOUTHWOOD PHARM 58016061690 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL SOUTHWOOD PHARM 58016062400 REMERON 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016062430 REMERON 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016062460 REMERON 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016062490 REMERON 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016066100 PAXIL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016066130 PAXIL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016066160 PAXIL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016066190 PAXIL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016066300 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL SOUTHWOOD PHARM 58016066330 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 277 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016066360 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL SOUTHWOOD PHARM 58016066390 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL SOUTHWOOD PHARM 58016066400 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016066430 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016066460 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016066490 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL SOUTHWOOD PHARM 58016066800 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016066830 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016066860 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016066890 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL SOUTHWOOD PHARM 58016067100 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL SOUTHWOOD PHARM 58016067102 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL SOUTHWOOD PHARM 58016067103 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL SOUTHWOOD PHARM 58016067130 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL SOUTHWOOD PHARM 58016067160 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL SOUTHWOOD PHARM 58016067190 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL SOUTHWOOD PHARM 58016068400 STELAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL SOUTHWOOD PHARM 58016068700 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM SOUTHWOOD PHARM 58016068730 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM SOUTHWOOD PHARM 58016068760 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM SOUTHWOOD PHARM 58016068790 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM SOUTHWOOD PHARM 58016070100 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070112 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070115 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070120 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070130 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070150 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070160 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070190 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL SOUTHWOOD PHARM 58016070400 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016070402 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016070403 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016070430 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016070460 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016070473 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016070489 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016070490 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL SOUTHWOOD PHARM 58016071000 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016071030 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 278 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016071060 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016071090 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016071099 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016071600 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL SOUTHWOOD PHARM 58016071612 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL SOUTHWOOD PHARM 58016071615 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL SOUTHWOOD PHARM 58016071620 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL SOUTHWOOD PHARM 58016071630 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL SOUTHWOOD PHARM 58016072000 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016072020 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016072028 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016072030 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016072060 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016072200 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072202 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072203 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072220 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072230 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072240 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072250 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072260 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072270 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072273 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072280 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072289 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072290 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL SOUTHWOOD PHARM 58016072300 REMERON 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016072330 REMERON 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016072360 REMERON 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016072390 REMERON 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016073100 PAXIL 40 MG TABLET 46225 PAROXETINE HCL SOUTHWOOD PHARM 58016073130 PAXIL 40 MG TABLET 46225 PAROXETINE HCL SOUTHWOOD PHARM 58016073160 PAXIL 40 MG TABLET 46225 PAROXETINE HCL SOUTHWOOD PHARM 58016073190 PAXIL 40 MG TABLET 46225 PAROXETINE HCL SOUTHWOOD PHARM 58016073200 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL SOUTHWOOD PHARM 58016073230 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL SOUTHWOOD PHARM 58016073260 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL SOUTHWOOD PHARM 58016073290 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL SOUTHWOOD PHARM 58016073500 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 279 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016073530 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL SOUTHWOOD PHARM 58016073560 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL SOUTHWOOD PHARM 58016073590 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL SOUTHWOOD PHARM 58016074200 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL SOUTHWOOD PHARM 58016074230 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL SOUTHWOOD PHARM 58016074260 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL SOUTHWOOD PHARM 58016074290 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL SOUTHWOOD PHARM 58016074900 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016074902 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016074930 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016074960 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016074990 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016076100 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL SOUTHWOOD PHARM 58016076130 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL SOUTHWOOD PHARM 58016076160 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL SOUTHWOOD PHARM 58016076190 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL SOUTHWOOD PHARM 58016076500 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL SOUTHWOOD PHARM 58016076530 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL SOUTHWOOD PHARM 58016076560 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL SOUTHWOOD PHARM 58016076590 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL SOUTHWOOD PHARM 58016077430 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM SOUTHWOOD PHARM 58016077460 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM SOUTHWOOD PHARM 58016077490 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM SOUTHWOOD PHARM 58016079700 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL SOUTHWOOD PHARM 58016079730 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL SOUTHWOOD PHARM 58016079760 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL SOUTHWOOD PHARM 58016079790 DOXEPIN 75 MG CAPSULE 46091 DOXEPIN HCL SOUTHWOOD PHARM 58016080300 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080302 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080303 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080305 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080312 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080315 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080320 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080330 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080360 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080373 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080389 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016080400 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 280 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016080402 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080403 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080412 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080415 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080420 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080430 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080473 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080489 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016080500 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM SOUTHWOOD PHARM 58016080502 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM SOUTHWOOD PHARM 58016080530 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM SOUTHWOOD PHARM 58016080560 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM SOUTHWOOD PHARM 58016080590 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM SOUTHWOOD PHARM 58016080600 PAXIL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016080630 PAXIL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016080660 PAXIL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016080690 PAXIL 30 MG TABLET 46224 PAROXETINE HCL SOUTHWOOD PHARM 58016080800 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016080830 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016080860 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016080890 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081300 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081302 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081303 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081310 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081312 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081315 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081320 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081324 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081330 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081350 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081360 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081373 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081389 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081390 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081399 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081400 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081402 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081415 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 281 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016081420 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081425 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081430 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081440 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081445 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081450 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081460 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081490 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081499 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081500 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081515 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081520 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081521 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081528 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081530 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081560 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081590 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081599 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016081700 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016081702 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016081703 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016081730 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016081760 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016081790 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL SOUTHWOOD PHARM 58016081800 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016081802 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016081803 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016081830 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016081860 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016081890 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL SOUTHWOOD PHARM 58016082100 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082108 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082110 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082112 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082114 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082115 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082120 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082121 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082124 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 282 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016082125 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082128 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082130 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082140 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082150 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082160 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082200 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082212 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082215 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082220 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082230 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016082810 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016082820 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016082830 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016082840 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016082860 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016082890 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016083215 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL SOUTHWOOD PHARM 58016083300 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083310 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083312 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083314 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083315 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083320 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083321 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083330 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083340 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083350 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083360 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083390 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL SOUTHWOOD PHARM 58016083400 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083410 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083414 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083415 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083420 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083421 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083430 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083440 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083450 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 283 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016083460 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083490 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL SOUTHWOOD PHARM 58016083730 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL SOUTHWOOD PHARM 58016083900 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL SOUTHWOOD PHARM 58016083912 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL SOUTHWOOD PHARM 58016083915 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL SOUTHWOOD PHARM 58016083920 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL SOUTHWOOD PHARM 58016083930 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL SOUTHWOOD PHARM 58016084000 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084002 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084003 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084010 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084012 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084014 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084015 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084018 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084020 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084021 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084024 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084025 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084028 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084030 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084040 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084060 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084073 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084089 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM SOUTHWOOD PHARM 58016084100 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL SOUTHWOOD PHARM 58016084112 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL SOUTHWOOD PHARM 58016084115 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL SOUTHWOOD PHARM 58016084120 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL SOUTHWOOD PHARM 58016084130 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL SOUTHWOOD PHARM 58016084330 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM SOUTHWOOD PHARM 58016084420 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM SOUTHWOOD PHARM 58016084709 XANAX 0.5MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016084760 XANAX 0.5MG TABLET 3774 ALPRAZOLAM SOUTHWOOD PHARM 58016085300 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085302 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085303 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085314 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 284 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016085315 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085320 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085328 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085330 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085350 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085360 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085373 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085389 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085390 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL SOUTHWOOD PHARM 58016085720 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016085730 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016085760 BUSPAR 5 MG TABLET 3782 BUSPIRONE HCL SOUTHWOOD PHARM 58016085800 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085814 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085821 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085828 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085830 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085840 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085850 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085860 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016085899 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL SOUTHWOOD PHARM 58016086200 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086203 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086212 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086215 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086220 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086230 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086250 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086260 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086273 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086289 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086290 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL SOUTHWOOD PHARM 58016086600 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SOUTHWOOD PHARM 58016086612 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SOUTHWOOD PHARM 58016086615 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SOUTHWOOD PHARM 58016086620 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SOUTHWOOD PHARM 58016086630 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL SOUTHWOOD PHARM 58016087500 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016087512 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 285 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016087515 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016087520 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016087530 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL SOUTHWOOD PHARM 58016088100 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016088102 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016088103 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016088130 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016088160 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016088190 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL SOUTHWOOD PHARM 58016089400 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016089402 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016089403 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016089430 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016089460 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016089490 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016089499 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE SOUTHWOOD PHARM 58016089700 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL SOUTHWOOD PHARM 58016089730 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL SOUTHWOOD PHARM 58016089760 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL SOUTHWOOD PHARM 58016089790 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL SOUTHWOOD PHARM 58016090500 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090502 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090503 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090510 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090520 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090530 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090560 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090573 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090589 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL SOUTHWOOD PHARM 58016090600 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090602 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090603 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090630 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090660 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090673 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090689 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090690 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL SOUTHWOOD PHARM 58016090700 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL SOUTHWOOD PHARM 58016090730 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 286 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016090760 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL SOUTHWOOD PHARM 58016090790 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL SOUTHWOOD PHARM 58016090900 PROVIGIL 100 MG TABLET 25848 MODAFINIL SOUTHWOOD PHARM 58016090930 PROVIGIL 100 MG TABLET 25848 MODAFINIL SOUTHWOOD PHARM 58016090960 PROVIGIL 100 MG TABLET 25848 MODAFINIL SOUTHWOOD PHARM 58016090990 PROVIGIL 100 MG TABLET 25848 MODAFINIL SOUTHWOOD PHARM 58016097600 PROVIGIL 200 MG TABLET 41478 MODAFINIL SOUTHWOOD PHARM 58016097630 PROVIGIL 200 MG TABLET 41478 MODAFINIL SOUTHWOOD PHARM 58016097660 PROVIGIL 200 MG TABLET 41478 MODAFINIL SOUTHWOOD PHARM 58016097690 PROVIGIL 200 MG TABLET 41478 MODAFINIL SOUTHWOOD PHARM 58016097700 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016097702 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016097730 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016097760 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016097790 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE SOUTHWOOD PHARM 58016098600 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016098602 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016098603 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016098630 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016098660 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016098690 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE SOUTHWOOD PHARM 58016099600 LIBRIUM 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016099630 LIBRIUM 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016099660 LIBRIUM 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016099690 LIBRIUM 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL SOUTHWOOD PHARM 58016482501 MIRTAZAPINE 15 MG ODT 47453 MIRTAZAPINE SOUTHWOOD PHARM 58016482601 MIRTAZAPINE 30 MG ODT 47454 MIRTAZAPINE SOUTHWOOD PHARM 58016869101 HALOPERIDOL LAC 2 MG/ML CONC 3971 HALOPERIDOL LACTATE SOUTHWOOD PHARM 58016869200 LORAZEPAM 1MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016869212 LORAZEPAM 1MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016869215 LORAZEPAM 1MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016869220 LORAZEPAM 1MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016869230 LORAZEPAM 1MG TABLET 3758 LORAZEPAM SOUTHWOOD PHARM 58016869700 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016869712 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016869715 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016869720 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016869730 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL SOUTHWOOD PHARM 58016983500 LORAZEPAM 2MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 287 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58016983512 LORAZEPAM 2MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016983515 LORAZEPAM 2MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016983520 LORAZEPAM 2MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58016983530 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM SOUTHWOOD PHARM 58177026404 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL ETHEX CORPORATION 58177026408 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL ETHEX CORPORATION 58177026422 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL ETHEX CORPORATION 58177026504 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ETHEX CORPORATION 58177026508 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ETHEX CORPORATION 58177026522 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL ETHEX CORPORATION 58177030904 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL ETHEX CORPORATION 58177030908 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL ETHEX CORPORATION 58177030922 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL ETHEX CORPORATION 58441112605 FLUPHENAZINE DEC 25MG/ML 3818 FLUPHENAZINE DECANOATE INSOURCE INC 58809071701 VANATRIP 50 MG TABLET 46047 AMITRIPTYLINE HCL GM PHARMACEUTICALS, INC. 58864001760 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PD-RX PHARM 58864002215 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PD-RX PHARM 58864002230 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PD-RX PHARM 58864002260 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PD-RX PHARM 58864002290 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PD-RX PHARM 58864002330 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PD-RX PHARM 58864002360 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PD-RX PHARM 58864002390 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PD-RX PHARM 58864002430 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PD-RX PHARM 58864002501 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PD-RX PHARM 58864002514 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PD-RX PHARM 58864002530 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PD-RX PHARM 58864003815 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PD-RX PHARM 58864003830 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PD-RX PHARM 58864008030 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL PD-RX PHARM 58864008130 CHLORDIAZEPOXIDE 25 MG CAP 3735 CHLORDIAZEPOXIDE HCL PD-RX PHARM 58864010315 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PD-RX PHARM 58864010330 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PD-RX PHARM 58864010360 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PD-RX PHARM 58864014430 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PD-RX PHARM 58864014520 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PD-RX PHARM 58864014530 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PD-RX PHARM 58864014560 DIAZEPAM 5MG TABLET 3768 DIAZEPAM PD-RX PHARM 58864014590 DIAZEPAM 5MG TABLET 3768 DIAZEPAM PD-RX PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 288 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58864014630 DIAZEPAM 10MG TABLET 3766 DIAZEPAM PD-RX PHARM 58864018530 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL PD-RX PHARM 58864018630 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL PD-RX PHARM 58864022215 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL PD-RX PHARM 58864029230 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL PD-RX PHARM 58864036615 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PD-RX PHARM 58864036630 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PD-RX PHARM 58864037215 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PD-RX PHARM 58864037230 PAXIL 20 MG TABLET 46223 PAROXETINE HCL PD-RX PHARM 58864061615 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PD-RX PHARM 58864061630 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PD-RX PHARM 58864062530 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PD-RX PHARM 58864062560 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PD-RX PHARM 58864062715 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PD-RX PHARM 58864062730 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PD-RX PHARM 58864062815 PAXIL 40 MG TABLET 46225 PAROXETINE HCL PD-RX PHARM 58864062930 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PD-RX PHARM 58864063030 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PD-RX PHARM 58864063060 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PD-RX PHARM 58864063098 DEPAKOTE EC 250 MG TABLET 4539 DIVALPROEX SODIUM PD-RX PHARM 58864066830 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE PD-RX PHARM 58864066842 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE PD-RX PHARM 58864069630 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL PD-RX PHARM 58864070115 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PD-RX PHARM 58864070430 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE PD-RX PHARM 58864070730 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PD-RX PHARM 58864070830 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL PD-RX PHARM 58864071530 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL PD-RX PHARM 58864071615 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PD-RX PHARM 58864071630 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PD-RX PHARM 58864073830 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PD-RX PHARM 58864073860 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PD-RX PHARM 58864074115 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PD-RX PHARM 58864074130 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PD-RX PHARM 58864075630 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PD-RX PHARM 58864075730 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL PD-RX PHARM 58864076815 ZYPREXA 5 MG TABLET 27961 OLANZAPINE PD-RX PHARM 58864078230 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PD-RX PHARM 58864078330 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PD-RX PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 289 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58864079430 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PD-RX PHARM 58864080240 FLUPHENAZINE 2.5 MG TABLET 3825 FLUPHENAZINE HCL PD-RX PHARM 58864080530 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM PD-RX PHARM 58864080560 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM PD-RX PHARM 58864080830 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PD-RX PHARM 58864080890 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PD-RX PHARM 58864081215 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PD-RX PHARM 58864081230 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PD-RX PHARM 58864081350 DIVALPROEX SOD 500 MG TAB EC 4540 DIVALPROEX SODIUM PD-RX PHARM 58864081960 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE PD-RX PHARM 58864082160 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE PD-RX PHARM 58864082215 ZYPREXA 5 MG TABLET 27961 OLANZAPINE PD-RX PHARM 58864082230 ZYPREXA 5 MG TABLET 27961 OLANZAPINE PD-RX PHARM 58864082315 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PD-RX PHARM 58864082330 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PD-RX PHARM 58864082530 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PD-RX PHARM 58864082830 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL PD-RX PHARM 58864082960 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PD-RX PHARM 58864083030 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PD-RX PHARM 58864083115 ZYPREXA 10 MG TABLET 27960 OLANZAPINE PD-RX PHARM 58864083930 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PD-RX PHARM 58864084030 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PD-RX PHARM 58864084060 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PD-RX PHARM 58864084130 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE PD-RX PHARM 58864084230 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL PD-RX PHARM 58864084430 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL PD-RX PHARM 58864084930 CELEXA 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PD-RX PHARM 58864085230 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PD-RX PHARM 58864086615 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PD-RX PHARM 58864086630 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PD-RX PHARM 58864087714 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PD-RX PHARM 58864088830 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE PD-RX PHARM 58864089330 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PD-RX PHARM 58864089630 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE PD-RX PHARM 58864095430 EFFEXOR XR 75 MG CAPSULE SA 46404 VENLAFAXINE HCL PD-RX PHARM 58864095830 GEODON 60 MG CAPSULE 47567 ZIPRASIDONE HCL PD-RX PHARM 58864096030 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL PD-RX PHARM 58864096130 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PD-RX PHARM 58864096230 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL PD-RX PHARM

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 290 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 58864096315 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PD-RX PHARM 58864096430 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL PD-RX PHARM 58864096815 ZYPREXA 10 MG TABLET 27960 OLANZAPINE PD-RX PHARM 58887011530 ANAFRANIL 25MG CAPSULE 46120 CLOMIPRAMINE HCL NOVARTIS PHARMACEUTICALS 58887011532 ANAFRANIL 25MG CAPSULE 46120 CLOMIPRAMINE HCL NOVARTIS PHARMACEUTICALS 58887011630 ANAFRANIL 50MG CAPSULE 46121 CLOMIPRAMINE HCL NOVARTIS PHARMACEUTICALS 58887011730 ANAFRANIL 75MG CAPSULE 46122 CLOMIPRAMINE HCL NOVARTIS PHARMACEUTICALS 58887011732 ANAFRANIL 75MG CAPSULE 46122 CLOMIPRAMINE HCL NOVARTIS PHARMACEUTICALS 59148000613 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE OTSUKA AMERICA 59148000635 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE OTSUKA AMERICA 59148000713 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE OTSUKA AMERICA 59148000735 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE OTSUKA AMERICA 59148000813 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE OTSUKA AMERICA 59148000835 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE OTSUKA AMERICA 59148000913 ABILIFY 15 MG TABLET 51334 ARIPIPRAZOLE OTSUKA AMERICA 59148000935 ABILIFY 15 MG TABLET 51334 ARIPIPRAZOLE OTSUKA AMERICA 59148001013 ABILIFY 20 MG TABLET 51335 ARIPIPRAZOLE OTSUKA AMERICA 59148001035 ABILIFY 20 MG TABLET 51335 ARIPIPRAZOLE OTSUKA AMERICA 59148001113 ABILIFY 30 MG TABLET 51336 ARIPIPRAZOLE OTSUKA AMERICA 59148001135 ABILIFY 30 MG TABLET 51336 ARIPIPRAZOLE OTSUKA AMERICA 59148001215 ABILIFY 1 MG/ML SOLUTION 58594 ARIPIPRAZOLE OTSUKA AMERICA 59148001315 ABILIFY 1 MG/ML SOLUTION 58594 ARIPIPRAZOLE OTSUKA AMERICA 59148001665 ABILIFY 9.7 MG/1.3 ML VIAL 61911 ARIPIPRAZOLE OTSUKA AMERICA 59148064023 ABILIFY DISCMELT 10 MG TABLET 60319 ARIPIPRAZOLE OTSUKA AMERICA 59148064123 ABILIFY DISCMELT 15 MG TABLET 60322 ARIPIPRAZOLE OTSUKA AMERICA 59417030171 ADAPIN 10MG CAPSULE 46086 DOXEPIN HCL SHIRE US, INC. 59417030271 ADAPIN 25MG CAPSULE 46089 DOXEPIN HCL SHIRE US, INC. 59417030371 ADAPIN 50MG CAPSULE 46090 DOXEPIN HCL SHIRE US, INC. 59417040171 TRIAVIL 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLSHIRE US, INC. 59417040271 TRIAVIL 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLSHIRE US, INC. 59417040471 TRIAVIL 25-4 TABLET 46187 PERPHENAZINE/AMITRIPTYLINE HCLSHIRE US, INC. 59591005168 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM WEST POINT PHARMA 59591005268 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM WEST POINT PHARMA 59591005368 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM WEST POINT PHARMA 59591005468 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM WEST POINT PHARMA 59630065860 KAPVAY ER 0.1 MG TABLET 66895 CLONIDINE HCL SCIELE PHARMA, INC. 59746001032 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE CADISTA PHARMACEUTICALS INC. 59746002022 RISPERIDONE 1 MG ODT 51799 RISPERIDONE CADISTA PHARMACEUTICALS INC. 59746003022 RISPERIDONE 2 MG ODT 51800 RISPERIDONE CADISTA PHARMACEUTICALS INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 291 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 59746004022 RISPERIDONE 3 MG ODT 59402 RISPERIDONE CADISTA PHARMACEUTICALS INC. 59746005022 RISPERIDONE 4 MG ODT 59403 RISPERIDONE CADISTA PHARMACEUTICALS INC. 59746024501 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59746024505 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59746024601 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59746024610 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59746024705 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59746024760 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59746024805 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59746024860 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE CADISTA PHARMACEUTICALS INC. 59762005701 ALPRAZOLAM XR 0.5 MG TABLET 50399 ALPRAZOLAM PFIZER, INC. 59762005901 ALPRAZOLAM XR 1 MG TABLET 50400 ALPRAZOLAM PFIZER, INC. 59762006601 ALPRAZOLAM XR 2 MG TABLET 50401 ALPRAZOLAM PFIZER, INC. 59762006801 ALPRAZOLAM XR 3 MG TABLET 52143 ALPRAZOLAM PFIZER, INC. 59762011901 PHENELZINE SULFATE 15 MG TAB 46263 PHENELZINE SULFATE PFIZER, INC. 59762018001 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL PFIZER, INC. 59762018002 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL PFIZER, INC. 59762018003 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL PFIZER, INC. 59762018004 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL PFIZER, INC. 59762018101 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PFIZER, INC. 59762018102 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PFIZER, INC. 59762018103 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PFIZER, INC. 59762018104 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL PFIZER, INC. 59762018201 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL PFIZER, INC. 59762018202 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL PFIZER, INC. 59762018203 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL PFIZER, INC. 59762018204 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL PFIZER, INC. 59762130301 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM PFIZER, INC. 59762130401 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM PFIZER, INC. 59762130501 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM PFIZER, INC. 59762141007 MIRTAZAPINE 15 MG ODT 47453 MIRTAZAPINE PFIZER, INC. 59762141207 MIRTAZAPINE 30 MG ODT 47454 MIRTAZAPINE PFIZER, INC. 59762141407 MIRTAZAPINE 45 MG ODT 47636 MIRTAZAPINE PFIZER, INC. 59762141503 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE PFIZER, INC. 59762141505 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE PFIZER, INC. 59762141506 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE PFIZER, INC. 59762141509 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE PFIZER, INC. 59762141603 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PFIZER, INC. 59762141605 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PFIZER, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 292 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 59762141606 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PFIZER, INC. 59762141609 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PFIZER, INC. 59762141703 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PFIZER, INC. 59762141705 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PFIZER, INC. 59762141706 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PFIZER, INC. 59762141709 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PFIZER, INC. 59762141803 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PFIZER, INC. 59762141805 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PFIZER, INC. 59762141806 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PFIZER, INC. 59762141809 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PFIZER, INC. 59762180801 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PFIZER, INC. 59762180802 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PFIZER, INC. 59762180803 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PFIZER, INC. 59762181001 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PFIZER, INC. 59762181002 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PFIZER, INC. 59762181003 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PFIZER, INC. 59762181004 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PFIZER, INC. 59762181201 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PFIZER, INC. 59762181202 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PFIZER, INC. 59762181203 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PFIZER, INC. 59762181501 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PFIZER, INC. 59762181502 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PFIZER, INC. 59762181503 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PFIZER, INC. 59762200101 ZIPRASIDONE HCL 20 MG CAPSULE 47563 ZIPRASIDONE HCL PFIZER, INC. 59762200201 ZIPRASIDONE HCL 40 MG CAPSULE 47564 ZIPRASIDONE HCL PFIZER, INC. 59762200301 ZIPRASIDONE HCL 60 MG CAPSULE 47567 ZIPRASIDONE HCL PFIZER, INC. 59762200401 ZIPRASIDONE HCL 80 MG CAPSULE 47568 ZIPRASIDONE HCL PFIZER, INC. 59762200402 ZIPRASIDONE HCL 80 MG CAPSULE 47568 ZIPRASIDONE HCL PFIZER, INC. 59762204002 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE PFIZER, INC. 59762204008 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE PFIZER, INC. 59762204102 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE PFIZER, INC. 59762204108 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE PFIZER, INC. 59762204202 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE PFIZER, INC. 59762204208 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE PFIZER, INC. 59762204302 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE PFIZER, INC. 59762204308 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE PFIZER, INC. 59762246002 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE PFIZER, INC. 59762246005 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE PFIZER, INC. 59762246008 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE PFIZER, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 293 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 59762246102 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE PFIZER, INC. 59762246105 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE PFIZER, INC. 59762246108 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE PFIZER, INC. 59762348003 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL PFIZER, INC. 59762348102 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL PFIZER, INC. 59762348202 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL PFIZER, INC. 59762348302 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL PFIZER, INC. 59762348402 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL PFIZER, INC. 59762371901 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PFIZER, INC. 59762371903 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PFIZER, INC. 59762371904 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PFIZER, INC. 59762372001 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PFIZER, INC. 59762372003 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PFIZER, INC. 59762372004 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PFIZER, INC. 59762372101 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PFIZER, INC. 59762372103 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PFIZER, INC. 59762372104 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PFIZER, INC. 59762372201 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PFIZER, INC. 59762372203 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM PFIZER, INC. 59762480001 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480003 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480005 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480006 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480101 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480103 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480105 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480106 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480201 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480203 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480205 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762480206 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PFIZER, INC. 59762490001 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC. 59762490002 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC. 59762490003 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC. 59762490004 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC. 59762490005 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL PFIZER, INC. 59762491001 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC. 59762491002 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC. 59762491003 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 294 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 59762491004 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC. 59762491005 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PFIZER, INC. 59762494001 SERTRALINE 20 MG/ML ORAL CONC 46230 SERTRALINE HCL PFIZER, INC. 59762496001 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL PFIZER, INC. 59772317101 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL APOTHECON, INC. 59772317102 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL APOTHECON, INC. 59772879001 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM APOTHECON, INC. 59772879002 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM APOTHECON, INC. 59772879101 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM APOTHECON, INC. 59772879102 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM APOTHECON, INC. 59772879201 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM APOTHECON, INC. 59772879202 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM APOTHECON, INC. 59772879301 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM APOTHECON, INC. 59911581101 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ESI LEDERLE INC. 59911581102 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM ESI LEDERLE INC. 59911581201 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ESI LEDERLE INC. 59911581202 LORAZEPAM 1MG TABLET 3758 LORAZEPAM ESI LEDERLE INC. 59911581301 LORAZEPAM 2MG TABLET 3759 LORAZEPAM ESI LEDERLE INC. 59911587601 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM ESI LEDERLE INC. 59911587701 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM ESI LEDERLE INC. 59911587801 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM ESI LEDERLE INC. 59930160001 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE WARRICK PHARMACEUTICALS 59930160301 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE WARRICK PHARMACEUTICALS 59930160501 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE WARRICK PHARMACEUTICALS 59930161001 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE WARRICK PHARMACEUTICALS 60258046404 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE CYPRESS PHARMACEUTICAL, LLC 60258083008 CITALOPRAM 10 MG/5 ML SOLUTION 46205 CITALOPRAM HYDROBROMIDE CYPRESS PHARMACEUTICAL, LLC 60346000414 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL QUALITY CARE PH 60346000430 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL QUALITY CARE PH 60346000445 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL QUALITY CARE PH 60346001430 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL QUALITY CARE PH 60346001445 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL QUALITY CARE PH 60346002712 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL QUALITY CARE PH 60346002730 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL QUALITY CARE PH 60346002760 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL QUALITY CARE PH 60346002790 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL QUALITY CARE PH 60346003302 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003306 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003310 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 295 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60346003315 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003320 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003330 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003360 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003390 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003394 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346003398 DIAZEPAM 10MG TABLET 3766 DIAZEPAM QUALITY CARE PH 60346004706 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004708 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004720 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004725 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004730 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004744 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004760 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004790 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346004794 LORAZEPAM 1MG TABLET 3758 LORAZEPAM QUALITY CARE PH 60346005110 XANAX 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346005120 XANAX 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346005130 XANAX 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346005160 XANAX 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346005206 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346005225 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346005230 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346005290 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346007510 XANAX 1MG TABLET 3775 ALPRAZOLAM QUALITY CARE PH 60346007530 XANAX 1MG TABLET 3775 ALPRAZOLAM QUALITY CARE PH 60346016230 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL QUALITY CARE PH 60346016290 BUSPAR 10MG TABLET 3781 BUSPIRONE HCL QUALITY CARE PH 60346017514 SERZONE 200MG TABLET 46256 NEFAZODONE HCL QUALITY CARE PH 60346022490 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL QUALITY CARE PH 60346026000 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346026008 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346026012 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346026025 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346026030 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL QUALITY CARE PH 60346026930 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL QUALITY CARE PH 60346035415 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL QUALITY CARE PH 60346035430 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL QUALITY CARE PH 60346035460 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL QUALITY CARE PH

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 296 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60346036330 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM QUALITY CARE PH 60346036390 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM QUALITY CARE PH 60346040960 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM QUALITY CARE PH 60346043906 VALIUM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346046020 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL QUALITY CARE PH 60346046030 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL QUALITY CARE PH 60346047806 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346047810 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346047815 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346047820 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346047830 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346047860 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346047890 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346047894 DIAZEPAM 5MG TABLET 3768 DIAZEPAM QUALITY CARE PH 60346050420 DESYREL 50MG TABLET 46241 TRAZODONE HCL QUALITY CARE PH 60346051612 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL QUALITY CARE PH 60346051630 ZOLOFT 50MG TABLET 46228 SERTRALINE HCL QUALITY CARE PH 60346054905 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM QUALITY CARE PH 60346055330 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL QUALITY CARE PH 60346056710 XANAX 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346056715 XANAX 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346056720 XANAX 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346056730 XANAX 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346056790 XANAX 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346057912 DIAZEPAM 2MG TABLET 3767 DIAZEPAM QUALITY CARE PH 60346057920 DIAZEPAM 2MG TABLET 3767 DIAZEPAM QUALITY CARE PH 60346057930 DIAZEPAM 2MG TABLET 3767 DIAZEPAM QUALITY CARE PH 60346057994 DIAZEPAM 2MG TABLET 3767 DIAZEPAM QUALITY CARE PH 60346062030 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL QUALITY CARE PH 60346062090 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL QUALITY CARE PH 60346067330 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL QUALITY CARE PH 60346067350 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL QUALITY CARE PH 60346067360 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL QUALITY CARE PH 60346067390 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL QUALITY CARE PH 60346070715 ZOLOFT 100MG TABLET 46229 SERTRALINE HCL QUALITY CARE PH 60346070730 ZOLOFT 100MG TABLET 46229 SERTRALINE HCL QUALITY CARE PH 60346070930 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL QUALITY CARE PH 60346070990 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL QUALITY CARE PH 60346071820 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL QUALITY CARE PH

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 297 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60346071830 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL QUALITY CARE PH 60346073130 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL QUALITY CARE PH 60346073140 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL QUALITY CARE PH 60346073230 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL QUALITY CARE PH 60346073240 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL QUALITY CARE PH 60346075725 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL QUALITY CARE PH 60346075745 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL QUALITY CARE PH 60346075750 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL QUALITY CARE PH 60346078530 AMITRIPTYLINE HCL 75MG TAB 46048 AMITRIPTYLINE HCL QUALITY CARE PH 60346079330 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL QUALITY CARE PH 60346079930 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE QUALITY CARE PH 60346079990 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE QUALITY CARE PH 60346079994 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE QUALITY CARE PH 60346080010 LORAZEPAM 2MG TABLET 3759 LORAZEPAM QUALITY CARE PH 60346080030 LORAZEPAM 2MG TABLET 3759 LORAZEPAM QUALITY CARE PH 60346081930 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL QUALITY CARE PH 60346082030 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL QUALITY CARE PH 60346082130 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL QUALITY CARE PH 60346082230 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL QUALITY CARE PH 60346083430 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE QUALITY CARE PH 60346083530 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE QUALITY CARE PH 60346083830 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL QUALITY CARE PH 60346083930 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL QUALITY CARE PH 60346084030 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL QUALITY CARE PH 60346084130 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE QUALITY CARE PH 60346084230 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE QUALITY CARE PH 60346084330 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE QUALITY CARE PH 60346086103 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346086114 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346086120 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346086130 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346086160 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346086190 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM QUALITY CARE PH 60346086690 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM QUALITY CARE PH 60346087610 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346087620 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346087630 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346087690 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM QUALITY CARE PH 60346092130 AMITRIP/CDP 25-10 TABLET 46192 AMITRIP HCL/CHLORDIAZEPOXIDEQUALITY CARE PH

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 298 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60346092330 AMITRIP/CDP 12.5-5 TABLET 46191 AMITRIP HCL/CHLORDIAZEPOXIDEQUALITY CARE PH 60346093230 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM QUALITY CARE PH 60429001612 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429001618 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429001630 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429001660 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429001690 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429001730 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429001760 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429001790 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429004230 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429004290 CHLORPROMAZINE 50MG TABLET 3800 CHLORPROMAZINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429004330 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429004390 CHLORPROMAZINE 100MG TABLET 3797 CHLORPROMAZINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429009501 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429009601 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429009701 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429017301 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017310 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017330 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017401 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017410 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017430 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017501 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017510 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429017530 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE GOLDEN STATE MEDICAL SUPPLY, INC. 60429018690 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE GOLDEN STATE MEDICAL SUPPLY, INC. 60429018701 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018705 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018730 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018760 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018790 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018801 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018805 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018830 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018860 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429018890 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429023001 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429023005 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 299 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60429023030 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429023090 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429026701 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429028730 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429028790 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429028830 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429028890 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429028930 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429028990 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429050212 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050215 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050218 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050230 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050260 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050290 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050312 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050315 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050318 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050330 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050345 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050360 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050390 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050412 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050415 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050418 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050430 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050460 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050515 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050518 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429050560 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429051230 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429051260 LORAZEPAM 1MG TABLET 3758 LORAZEPAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429051290 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM GOLDEN STATE MEDICAL SUPPLY, INC. 60429052701 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM GOLDEN STATE MEDICAL SUPPLY, INC. 60429052705 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM GOLDEN STATE MEDICAL SUPPLY, INC. 60429052801 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM GOLDEN STATE MEDICAL SUPPLY, INC. 60429052805 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM GOLDEN STATE MEDICAL SUPPLY, INC. 60429052901 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM GOLDEN STATE MEDICAL SUPPLY, INC. 60429055401 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL GOLDEN STATE MEDICAL SUPPLY, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 300 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60429055501 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429055601 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071818 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071830 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071860 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071890 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071918 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071930 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071960 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429071990 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429072718 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429072760 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073405 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073430 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073490 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073501 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073505 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073530 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073590 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073605 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073630 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073690 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073705 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073715 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073730 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073745 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429073790 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429074601 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429074701 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429075801 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429075901 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429075930 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429075990 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429076001 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429076030 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429076090 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE GOLDEN STATE MEDICAL SUPPLY, INC. 60429093001 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429093005 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429094601 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL GOLDEN STATE MEDICAL SUPPLY, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 301 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60429094605 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429094701 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429094705 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429098701 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429098705 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429098801 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60429098805 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL GOLDEN STATE MEDICAL SUPPLY, INC. 60432016204 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL MORTON GROVE PHARMACEUTICALS, INC 60432061616 LITHIUM CITRATE 8 MEQ/5 ML SOL 4006 LITHIUM CITRATE MORTON GROVE PHARMACEUTICALS, INC 60432062116 VALPROIC ACID 250 MG/5 ML SOLN 4535 VALPROATE SODIUM MORTON GROVE PHARMACEUTICALS, INC 60432065104 DOXEPIN 10 MG/ML ORAL CONC 46092 DOXEPIN HCL MORTON GROVE PHARMACEUTICALS, INC 60505007800 BUSPIRONE HCL 5MG TABLET 3782 BUSPIRONE HCL APOTEX CORP. 60505007801 BUSPIRONE HCL 5MG TABLET 3782 BUSPIRONE HCL APOTEX CORP. 60505007900 BUSPIRONE HCL 10MG TABLET 3781 BUSPIRONE HCL APOTEX CORP. 60505007901 BUSPIRONE HCL 10MG TABLET 3781 BUSPIRONE HCL APOTEX CORP. 60505008300 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL APOTEX CORP. 60505008301 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL APOTEX CORP. 60505008302 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL APOTEX CORP. 60505008304 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL APOTEX CORP. 60505008401 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL APOTEX CORP. 60505008402 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL APOTEX CORP. 60505008404 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL APOTEX CORP. 60505009701 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL APOTEX CORP. 60505009702 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL APOTEX CORP. 60505009704 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL APOTEX CORP. 60505010101 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL APOTEX CORP. 60505010102 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL APOTEX CORP. 60505010104 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL APOTEX CORP. 60505010107 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL APOTEX CORP. 60505010300 BUSPIRONE HCL 15MG TABLET 27378 BUSPIRONE HCL APOTEX CORP. 60505010301 BUSPIRONE HCL 15MG TABLET 27378 BUSPIRONE HCL APOTEX CORP. 60505015701 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL APOTEX CORP. 60505015705 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL APOTEX CORP. 60505015709 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL APOTEX CORP. 60505015801 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL APOTEX CORP. 60505015805 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL APOTEX CORP. 60505015809 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL APOTEX CORP. 60505016401 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE APOTEX CORP. 60505016501 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE APOTEX CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 302 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60505016601 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE APOTEX CORP. 60505018003 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL APOTEX CORP. 60505018008 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL APOTEX CORP. 60505018103 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL APOTEX CORP. 60505018108 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL APOTEX CORP. 60505018203 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL APOTEX CORP. 60505018208 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL APOTEX CORP. 60505024701 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE APOTEX CORP. 60505024708 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE APOTEX CORP. 60505024801 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE APOTEX CORP. 60505024808 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE APOTEX CORP. 60505024901 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE APOTEX CORP. 60505024908 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE APOTEX CORP. 60505035201 FLUOXETINE 20 MG/5 ML SOLUTION 46217 FLUOXETINE HCL APOTEX CORP. 60505037401 PAROXETINE HCL 10 MG/5 ML SUSP 46226 PAROXETINE HCL APOTEX CORP. 60505038001 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE APOTEX CORP. 60505040205 PAXIL 10 MG/5 ML SUSPENSION 46226 PAROXETINE HCL APOTEX CORP. 60505066402 FLUPHENAZINE DEC 25 MG/ML VL 3818 FLUPHENAZINE DECANOATE APOTEX CORP. 60505070201 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE APOTEX CORP. 60505070301 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE APOTEX CORP. 60505072703 HALOPERIDOL LAC 5 MG/ML SYRN 58664 HALOPERIDOL LACTATE APOTEX CORP. 60505250401 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE APOTEX CORP. 60505250402 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE APOTEX CORP. 60505250403 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE APOTEX CORP. 60505251801 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505251803 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505251804 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505251808 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505251901 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505251903 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505251904 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505251908 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505252001 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505252003 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505252004 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505252008 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE APOTEX CORP. 60505258400 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE APOTEX CORP. 60505258405 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE APOTEX CORP. 60505258406 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE APOTEX CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 303 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60505258500 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE APOTEX CORP. 60505258505 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE APOTEX CORP. 60505258506 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE APOTEX CORP. 60505258600 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE APOTEX CORP. 60505258605 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE APOTEX CORP. 60505258606 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE APOTEX CORP. 60505258700 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE APOTEX CORP. 60505258705 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE APOTEX CORP. 60505258706 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE APOTEX CORP. 60505258800 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE APOTEX CORP. 60505258805 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE APOTEX CORP. 60505258806 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE APOTEX CORP. 60505258900 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE APOTEX CORP. 60505258906 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE APOTEX CORP. 60505265300 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL APOTEX CORP. 60505265301 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL APOTEX CORP. 60505265305 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL APOTEX CORP. 60505265307 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL APOTEX CORP. 60505265400 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL APOTEX CORP. 60505265401 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL APOTEX CORP. 60505265405 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL APOTEX CORP. 60505265407 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL APOTEX CORP. 60505265501 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL APOTEX CORP. 60505265505 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL APOTEX CORP. 60505265507 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL APOTEX CORP. 60505265901 TRAZODONE 300 MG TABLET 46244 TRAZODONE HCL APOTEX CORP. 60505266301 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE APOTEX CORP. 60505266305 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE APOTEX CORP. 60505266401 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE APOTEX CORP. 60505266405 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE APOTEX CORP. 60505266505 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE APOTEX CORP. 60505266506 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE APOTEX CORP. 60505268005 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE APOTEX CORP. 60505268006 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE APOTEX CORP. 60505292007 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL APOTEX CORP. 60505292107 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL APOTEX CORP. 60505292207 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL APOTEX CORP. 60505306501 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM APOTEX CORP. 60505306601 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM APOTEX CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 304 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60505306605 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM APOTEX CORP. 60505306701 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM APOTEX CORP. 60505306705 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM APOTEX CORP. 60505313001 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE APOTEX CORP. 60505313008 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE APOTEX CORP. 60505313201 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE APOTEX CORP. 60505313208 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE APOTEX CORP. 60505313301 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE APOTEX CORP. 60505313308 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE APOTEX CORP. 60505313501 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE APOTEX CORP. 60505313508 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE APOTEX CORP. 60505313706 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE APOTEX CORP. 60505313901 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE APOTEX CORP. 60505327500 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE APOTEX CORP. 60505327503 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE APOTEX CORP. 60505327600 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE APOTEX CORP. 60505327603 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE APOTEX CORP. 60505327700 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE APOTEX CORP. 60505327703 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE APOTEX CORP. 60505327800 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE APOTEX CORP. 60505327803 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE APOTEX CORP. 60505366303 PAXIL 10 MG TABLET 46222 PAROXETINE HCL APOTEX CORP. 60505366403 PAXIL 20 MG TABLET 46223 PAROXETINE HCL APOTEX CORP. 60505366503 PAXIL 30 MG TABLET 46224 PAROXETINE HCL APOTEX CORP. 60505366603 PAXIL 40 MG TABLET 46225 PAROXETINE HCL APOTEX CORP. 60505366803 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL APOTEX CORP. 60505366903 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL APOTEX CORP. 60505367003 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL APOTEX CORP. 60505367303 PAROXETINE CR 12.5 MG TABLET 50137 PAROXETINE HCL APOTEX CORP. 60505367403 PAROXETINE CR 25 MG TABLET 50136 PAROXETINE HCL APOTEX CORP. 60505367503 PAROXETINE CR 37.5 MG TABLET 50138 PAROXETINE HCL APOTEX CORP. 60505377803 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL APOTEX CORP. 60505377809 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL APOTEX CORP. 60505377903 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL APOTEX CORP. 60505377909 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL APOTEX CORP. 60505378003 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL APOTEX CORP. 60505378009 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL APOTEX CORP. 60505602002 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE APOTEX CORP. 60505602102 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE APOTEX CORP.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 305 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60760000930 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE ST MARYS MPP 60760012130 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL ST MARYS MPP 60760021215 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ST MARYS MPP 60760021230 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL ST MARYS MPP 60760021430 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL ST MARYS MPP 60760032330 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL ST MARYS MPP 60760032430 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL ST MARYS MPP 60760036730 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ST MARYS MPP 60760036760 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL ST MARYS MPP 60760043430 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL ST MARYS MPP 60760043460 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL ST MARYS MPP 60760044030 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ST MARYS MPP 60760044060 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL ST MARYS MPP 60760045710 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ST MARYS MPP 60760045730 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM ST MARYS MPP 60760050830 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL ST MARYS MPP 60760050860 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL ST MARYS MPP 60760064730 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL ST MARYS MPP 60760077510 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ST MARYS MPP 60760077530 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM ST MARYS MPP 60760077630 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM ST MARYS MPP 60760080960 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM ST MARYS MPP 60760081130 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL ST MARYS MPP 60760083960 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ST MARYS MPP 60793001201 FLUPHENAZINE DEC 25MG/ML VL 3818 FLUPHENAZINE DECANOATE KING PHARMACEUTICALS, INC. 60809010455 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809010472 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809010555 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809010572 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809012655 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809012672 THIORIDAZINE 50MG TABLET 3865 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015155 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015172 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015255 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015272 THIORIDAZINE 15MG TABLET 3861 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015355 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015372 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015455 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809015472 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 306 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 60809017355 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809017372 THIORIDAZINE 200MG TABLET 3863 THIORIDAZINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030455 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030472 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030555 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030572 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030655 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030672 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030755 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809030772 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL GLASGOW PHARMACEUTICAL CORPORATION 60809050255 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM GLASGOW PHARMACEUTICAL CORPORATION 60809050272 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM GLASGOW PHARMACEUTICAL CORPORATION 60809050455 LORAZEPAM 1MG TABLET 3758 LORAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60809050472 LORAZEPAM 1MG TABLET 3758 LORAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60809050555 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60809050572 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60809051055 DIAZEPAM 2MG TABLET 3767 DIAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60809051072 DIAZEPAM 2MG TABLET 3767 DIAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60809051155 DIAZEPAM 5MG TABLET 3768 DIAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60809051172 DIAZEPAM 5MG TABLET 3768 DIAZEPAM GLASGOW PHARMACEUTICAL CORPORATION 60814058560 ST. JOHN'S WORT 150MG CAP 46331 ST. JOHN'S WORT REXALL SUNDOWN, INC. 61073003301 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AMKAS LABORATORIES INC. 61073003401 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AMKAS LABORATORIES INC. 61073003501 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AMKAS LABORATORIES INC. 61073003630 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMKAS LABORATORIES INC. 61073003730 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AMKAS LABORATORIES INC. 61073003830 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AMKAS LABORATORIES INC. 61392002530 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002531 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002532 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002539 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002545 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002551 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002554 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002556 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002560 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002590 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002591 IMIPRAMINE HCL 10MG TABLET 46068 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002630 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 307 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392002631 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002632 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002639 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002645 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002651 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002654 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002656 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002660 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002690 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002691 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002730 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002731 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002732 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002739 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002745 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002751 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002754 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002756 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002760 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002790 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392002791 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL HEARTLAND HEALTHCARE SERVICES 61392003430 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003431 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003432 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003439 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003445 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003451 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003454 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003456 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003460 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003490 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003491 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003530 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003531 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003532 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003539 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003545 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003551 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003554 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 308 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392003556 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003560 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003590 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003591 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003630 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003631 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003632 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003639 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003645 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003651 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003654 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003656 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003660 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003690 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003691 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003730 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003731 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003732 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003739 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003745 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003751 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003754 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003756 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003760 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003790 ALPRAZOLAM 2MG TABLET 15566 ALPRAZOLAM HEARTLAND HEALTHCARE SERVICES 61392003930 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003931 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003932 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003939 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003945 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003951 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003954 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003956 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003960 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003990 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392003991 CHLORPROMAZINE 10MG TABLET 3796 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004030 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004031 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004032 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 309 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392004039 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004045 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004051 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004054 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004056 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004060 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004090 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392004091 CHLORPROMAZINE 25MG TABLET 3799 CHLORPROMAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005730 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005731 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005732 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005739 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005745 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005751 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005754 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005760 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005790 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005791 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005830 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005831 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005832 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005839 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005845 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005851 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005854 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005860 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005890 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005891 3825 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005930 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005931 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005932 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005939 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005945 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005951 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005954 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005960 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005990 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392005991 3826 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006030 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 310 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392006031 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006032 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006039 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006045 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006051 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006054 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006060 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006090 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392006091 3824 FLUPHENAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392007130 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007131 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007132 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007139 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007145 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007151 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007154 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007160 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007190 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007191 AMITRIP/PERPHEN 10-2 TABLET 46184 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007230 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007231 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007232 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007239 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007245 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007251 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007254 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007260 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007290 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392007291 AMITRIP/PERPHEN 25-2 TABLET 46186 PERPHENAZINE/AMITRIPTYLINE HCLHEARTLAND HEALTHCARE SERVICES 61392008130 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008131 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008132 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008139 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008145 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008151 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008154 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008156 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008160 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008190 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 311 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392008191 PERPHENAZINE 4MG TABLET 3832 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008230 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008231 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008232 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008239 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008245 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008251 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008254 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008256 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008260 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008290 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392008291 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392012130 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012131 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012132 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012139 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012145 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012151 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012154 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012160 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012190 HALOPERIDOL 20MG TABLET 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392012191 3976 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392013130 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013131 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013132 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013139 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013145 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013151 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013154 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013160 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013190 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392013191 LITHIUM CARBONATE 300MG CAP 4001 LITHIUM CARBONATE HEARTLAND HEALTHCARE SERVICES 61392014030 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014031 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014032 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014034 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014039 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014045 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014051 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 312 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392014054 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014056 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014060 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014090 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014091 AMITRIPTYLINE HCL 25MG TAB 46046 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014130 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014131 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014132 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014139 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014145 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014151 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014154 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014156 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014160 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014190 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014191 AMITRIPTYLINE HCL 50MG TAB 46047 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014230 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014231 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014232 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014239 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014245 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014251 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014254 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014260 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014290 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014291 PERPHENAZINE 8MG TABLET 3833 PERPHENAZINE HEARTLAND HEALTHCARE SERVICES 61392014330 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014331 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014332 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014334 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014339 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014345 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014351 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014354 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014356 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014360 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014390 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392014391 AMITRIPTYLINE HCL 10MG TAB 46043 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015130 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 313 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392015131 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015132 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015139 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015145 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015151 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015154 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015160 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015190 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015191 3852 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015230 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015231 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015232 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015239 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015245 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015251 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015254 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015260 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015290 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015291 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015330 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015331 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015332 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015339 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015345 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015351 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015354 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015356 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015360 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015390 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015391 AMITRIPTYLINE HCL 100MG TAB 46044 AMITRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392015430 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015431 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015432 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015439 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015445 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015451 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015454 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015460 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015490 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 314 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392015491 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392015730 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015731 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015732 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015739 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015745 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015751 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015754 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015760 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015790 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392015791 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID HEARTLAND HEALTHCARE SERVICES 61392023430 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023451 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023454 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023456 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023460 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023490 PROZAC 10MG PULVULE 46213 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023515 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023530 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023545 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023551 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023554 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023556 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023560 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392023590 PROZAC 20MG PULVULE 46214 FLUOXETINE HCL HEARTLAND HEALTHCARE SERVICES 61392026315 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026330 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026331 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026332 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026339 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026345 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026351 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026354 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026356 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026360 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026390 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026391 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026615 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026630 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 315 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392026631 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026632 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026639 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026645 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026651 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026654 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026656 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026660 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026690 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026691 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026915 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026930 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026931 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026932 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026939 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026945 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026951 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026954 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026956 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026960 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026990 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392026991 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027230 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027231 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027232 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027239 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027245 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027251 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027254 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027256 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027260 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027290 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027291 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027530 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027531 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027532 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027539 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027545 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027551 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 316 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392027554 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027556 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027560 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392027590 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL HEARTLAND HEALTHCARE SERVICES 61392036130 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036131 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036132 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036139 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036145 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036151 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036154 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036156 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036160 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036190 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036191 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036430 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036431 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036432 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036439 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036445 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036451 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036454 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036456 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036460 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036490 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036491 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036730 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036731 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036732 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036739 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036745 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036751 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036754 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036756 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036760 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036790 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392036791 46061 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037030 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037031 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 317 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392037032 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037039 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037045 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037051 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037054 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037056 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037060 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037090 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL HEARTLAND HEALTHCARE SERVICES 61392037330 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037331 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037332 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037339 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037345 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037351 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037354 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037356 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037360 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037390 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037391 OXAZEPAM 10MG CAPSULE 3769 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037630 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037631 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037632 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037639 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037645 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037651 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037654 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037656 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037660 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037690 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037691 OXAZEPAM 15MG CAPSULE 3770 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037930 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037931 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037932 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037939 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037945 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037951 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037954 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037956 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037960 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 318 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392037990 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392037991 OXAZEPAM 30MG CAPSULE 3771 OXAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044930 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044931 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044932 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044939 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044945 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044951 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044954 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044956 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044960 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044990 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392044991 LORAZEPAM 1MG TABLET 3758 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045230 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045231 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045232 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045239 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045245 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045251 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045254 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045256 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045260 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045290 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045291 LORAZEPAM 2MG TABLET 3759 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045530 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045531 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045532 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045539 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045545 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045551 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045554 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045556 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045560 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045590 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392045591 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM HEARTLAND HEALTHCARE SERVICES 61392046215 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046230 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046231 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046232 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 319 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392046239 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046245 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046251 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046254 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046256 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046260 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046290 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046291 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046330 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046331 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046332 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046339 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046345 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046351 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046354 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046360 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046390 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046391 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046530 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046531 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046532 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046539 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046545 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046551 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046554 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046560 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046590 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392046591 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL HEARTLAND HEALTHCARE SERVICES 61392048730 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048731 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048732 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048739 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048745 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048751 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048754 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048756 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048760 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048790 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392048791 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 320 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392049015 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049030 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049031 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049032 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049039 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049045 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049051 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049054 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049056 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049060 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049090 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049091 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049130 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049131 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049132 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049139 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049145 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049151 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049154 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049160 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049190 TRAZODONE 150MG TABLET 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392049191 46243 TRAZODONE HCL HEARTLAND HEALTHCARE SERVICES 61392072130 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072131 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072132 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072139 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072145 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072151 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072154 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072160 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072190 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072191 DIAZEPAM 5MG TABLET 3768 DIAZEPAM HEARTLAND HEALTHCARE SERVICES 61392072630 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072631 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072632 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072639 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072645 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072651 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072654 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 321 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392072660 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072690 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072691 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072730 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072731 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072732 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072739 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072745 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072751 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072754 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072760 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072790 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072791 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072830 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072831 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072832 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072839 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072845 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072851 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072854 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072860 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072890 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072891 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072930 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072931 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072932 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072939 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072945 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072951 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072954 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072960 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072990 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392072991 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073030 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073031 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073032 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073039 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073045 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073051 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 322 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392073054 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073060 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073090 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392073091 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL HEARTLAND HEALTHCARE SERVICES 61392078830 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078831 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078832 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078839 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078845 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078851 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078854 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078860 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078890 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078891 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078930 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078931 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078932 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078939 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078945 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078951 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078954 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078960 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078990 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392078991 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079030 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079031 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079032 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079039 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079045 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079051 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079054 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079060 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079090 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079091 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079130 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079131 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079132 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079139 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079145 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 323 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 61392079151 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079154 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079160 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079190 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61392079191 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE HEARTLAND HEALTHCARE SERVICES 61703020607 DROPERIDOL 2.5MG/ML VIAL 3965 DROPERIDOL MAYNE PHARMA (USA) INC. 62037053801 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL WATSON PHARMA, INC. 62037053805 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL WATSON PHARMA, INC. 62037053810 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL WATSON PHARMA, INC. 62037053901 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL WATSON PHARMA, INC. 62037053905 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL WATSON PHARMA, INC. 62037053910 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL WATSON PHARMA, INC. 62037075310 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE WATSON PHARMA, INC. 62037075330 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE WATSON PHARMA, INC. 62037075410 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE WATSON PHARMA, INC. 62037075430 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE WATSON PHARMA, INC. 62037075510 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE WATSON PHARMA, INC. 62037075530 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE WATSON PHARMA, INC. 62037084530 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL WATSON PHARMA, INC. 62037084601 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL WATSON PHARMA, INC. 62037084610 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL WATSON PHARMA, INC. 62037084630 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL WATSON PHARMA, INC. 62037084730 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL WATSON PHARMA, INC. 62037084830 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL WATSON PHARMA, INC. 62269027824 TRIFLUOPERAZINE 1 MG TABLET 3851 TRIFLUOPERAZINE HCL APOTHECON/INVAMED 62269027924 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL APOTHECON/INVAMED 62269027930 TRIFLUOPERAZINE 2MG TABLET 3853 TRIFLUOPERAZINE HCL APOTHECON/INVAMED 62269028024 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL APOTHECON/INVAMED 62269028030 TRIFLUOPERAZINE 5MG TABLET 3854 TRIFLUOPERAZINE HCL APOTHECON/INVAMED 62269028124 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL APOTHECON/INVAMED 62269028130 TRIFLUOPERAZINE 10MG TABLET 3852 TRIFLUOPERAZINE HCL APOTHECON/INVAMED 62269032124 CLOMIPRAMINE 25MG CAPSULE 46120 CLOMIPRAMINE HCL APOTHECON/INVAMED 62269032224 CLOMIPRAMINE 50MG CAPSULE 46121 CLOMIPRAMINE HCL APOTHECON/INVAMED 62269032324 CLOMIPRAMINE 75MG CAPSULE 46122 CLOMIPRAMINE HCL APOTHECON/INVAMED 62269032824 NORTRIPTYLINE HCL 10MG CAP 46059 NORTRIPTYLINE HCL APOTHECON/INVAMED 62269032924 NORTRIPTYLINE HCL 25MG CAP 46060 NORTRIPTYLINE HCL APOTHECON/INVAMED 62269033024 NORTRIPTYLINE HCL 50MG CAP 46061 NORTRIPTYLINE HCL APOTHECON/INVAMED 62269033124 NORTRIPTYLINE HCL 75MG CAP 46062 NORTRIPTYLINE HCL APOTHECON/INVAMED 62451539013 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 324 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 62451539113 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 62559015801 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE ANIP ACQUISITION COMPANY 62559015901 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE ANIP ACQUISITION COMPANY 62559016001 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE ANIP ACQUISITION COMPANY 62584019390 FLUOXETINE HCL 20MG CAPSULE 46214 FLUOXETINE HCL AMERICAN HEALTH PACKAGING 62584033001 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 62584033011 CHLORPROMAZINE 25 MG TABLET 3799 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 62584033101 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 62584033111 CHLORPROMAZINE 100 MG TABLET 3797 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 62584055601 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMERICAN HEALTH PACKAGING 62584055680 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMERICAN HEALTH PACKAGING 62584055685 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMERICAN HEALTH PACKAGING 62584055701 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AMERICAN HEALTH PACKAGING 62584060901 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM AMERICAN HEALTH PACKAGING 62584060933 ALPRAZOLAM 0.25MG TABLET 3773 ALPRAZOLAM AMERICAN HEALTH PACKAGING 62584061001 ALPRAZOLAM 0.5MG TABLET 3774 ALPRAZOLAM AMERICAN HEALTH PACKAGING 62584061033 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM AMERICAN HEALTH PACKAGING 62584061101 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM AMERICAN HEALTH PACKAGING 62584061133 ALPRAZOLAM 1MG TABLET 3775 ALPRAZOLAM AMERICAN HEALTH PACKAGING 62584064601 CHLORDIAZEPOXIDE 5MG CAP 3736 CHLORDIAZEPOXIDE HCL AMERICAN HEALTH PACKAGING 62584064701 CHLORDIAZEPOXIDE 10MG CAP 3734 CHLORDIAZEPOXIDE HCL AMERICAN HEALTH PACKAGING 62584064801 CHLORDIAZEPOXIDE 25MG CAP 3735 CHLORDIAZEPOXIDE HCL AMERICAN HEALTH PACKAGING 62584066101 DESIPRAMINE 25MG TABLET 46106 DESIPRAMINE HCL AMERICAN HEALTH PACKAGING 62584066301 DESIPRAMINE 50MG TABLET 46107 DESIPRAMINE HCL AMERICAN HEALTH PACKAGING 62584066401 DESIPRAMINE 75MG TABLET 46108 DESIPRAMINE HCL AMERICAN HEALTH PACKAGING 62584066601 DIAZEPAM 2MG TABLET 3767 DIAZEPAM AMERICAN HEALTH PACKAGING 62584066633 DIAZEPAM 2MG TABLET 3767 DIAZEPAM AMERICAN HEALTH PACKAGING 62584066701 DIAZEPAM 5MG TABLET 3768 DIAZEPAM AMERICAN HEALTH PACKAGING 62584066733 DIAZEPAM 5MG TABLET 3768 DIAZEPAM AMERICAN HEALTH PACKAGING 62584066801 DIAZEPAM 10MG TABLET 3766 DIAZEPAM AMERICAN HEALTH PACKAGING 62584066833 DIAZEPAM 10MG TABLET 3766 DIAZEPAM AMERICAN HEALTH PACKAGING 62584067901 CLORAZEPATE 3.75MG TABLET 3745 CLORAZEPATE DIPOTASSIUM AMERICAN HEALTH PACKAGING 62584068001 CLORAZEPATE 7.5MG TABLET 3746 CLORAZEPATE DIPOTASSIUM AMERICAN HEALTH PACKAGING 62584068101 CLORAZEPATE 15MG TABLET 3744 CLORAZEPATE DIPOTASSIUM AMERICAN HEALTH PACKAGING 62584068601 DOXEPIN 10MG CAPSULE 46086 DOXEPIN HCL AMERICAN HEALTH PACKAGING 62584068701 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL AMERICAN HEALTH PACKAGING 62584068733 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL AMERICAN HEALTH PACKAGING 62584068801 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL AMERICAN HEALTH PACKAGING 62584068901 DOXEPIN 75MG CAPSULE 46091 DOXEPIN HCL AMERICAN HEALTH PACKAGING

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 325 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 62584069001 DOXEPIN 100MG CAPSULE 46087 DOXEPIN HCL AMERICAN HEALTH PACKAGING 62584069801 FLUPHENAZINE 1MG TABLET 3823 FLUPHENAZINE HCL AMERICAN HEALTH PACKAGING 62584069901 FLUPHENAZINE 2.5MG TABLET 3825 FLUPHENAZINE HCL AMERICAN HEALTH PACKAGING 62584070301 FLUPHENAZINE 5MG TABLET 3826 FLUPHENAZINE HCL AMERICAN HEALTH PACKAGING 62584070401 FLUPHENAZINE 10MG TABLET 3824 FLUPHENAZINE HCL AMERICAN HEALTH PACKAGING 62584072401 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072433 HALOPERIDOL 0.5MG TABLET 3972 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072501 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072533 HALOPERIDOL 1MG TABLET 3973 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072601 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072633 HALOPERIDOL 2MG TABLET 3975 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072701 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072733 HALOPERIDOL 5MG TABLET 3977 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584072801 HALOPERIDOL 10MG TABLET 3974 HALOPERIDOL AMERICAN HEALTH PACKAGING 62584075001 IMIPRAMINE HCL 25MG TABLET 46069 IMIPRAMINE HCL AMERICAN HEALTH PACKAGING 62584075101 IMIPRAMINE HCL 50MG TABLET 46070 IMIPRAMINE HCL AMERICAN HEALTH PACKAGING 62584076901 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM AMERICAN HEALTH PACKAGING 62584076933 LORAZEPAM 0.5MG TABLET 3757 LORAZEPAM AMERICAN HEALTH PACKAGING 62584077001 LORAZEPAM 1MG TABLET 3758 LORAZEPAM AMERICAN HEALTH PACKAGING 62584077033 LORAZEPAM 1MG TABLET 3758 LORAZEPAM AMERICAN HEALTH PACKAGING 62584077101 LORAZEPAM 2MG TABLET 3759 LORAZEPAM AMERICAN HEALTH PACKAGING 62584081201 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM AMERICAN HEALTH PACKAGING 62584081211 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM AMERICAN HEALTH PACKAGING 62584081301 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM AMERICAN HEALTH PACKAGING 62584081311 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM AMERICAN HEALTH PACKAGING 62584081401 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM AMERICAN HEALTH PACKAGING 62584081411 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM AMERICAN HEALTH PACKAGING 62584081601 PERPHENAZINE 2MG TABLET 3831 PERPHENAZINE AMERICAN HEALTH PACKAGING 62584081701 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE AMERICAN HEALTH PACKAGING 62584081711 PERPHENAZINE 4 MG TABLET 3832 PERPHENAZINE AMERICAN HEALTH PACKAGING 62584082001 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE AMERICAN HEALTH PACKAGING 62584082011 PERPHENAZINE 8 MG TABLET 3833 PERPHENAZINE AMERICAN HEALTH PACKAGING 62584082101 PERPHENAZINE 16MG TABLET 3830 PERPHENAZINE AMERICAN HEALTH PACKAGING 62584087301 THIORIDAZINE 10MG TABLET 3859 THIORIDAZINE HCL AMERICAN HEALTH PACKAGING 62584087401 THIORIDAZINE 25MG TABLET 3864 THIORIDAZINE HCL AMERICAN HEALTH PACKAGING 62584087501 THIOTHIXENE 1MG CAPSULE 3995 THIOTHIXENE AMERICAN HEALTH PACKAGING 62584087601 THIOTHIXENE 2MG CAPSULE 3997 THIOTHIXENE AMERICAN HEALTH PACKAGING 62584087701 THIOTHIXENE 5MG CAPSULE 3999 THIOTHIXENE AMERICAN HEALTH PACKAGING 62584087801 THIOTHIXENE 10MG CAPSULE 3996 THIOTHIXENE AMERICAN HEALTH PACKAGING

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 326 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 62584088201 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL AMERICAN HEALTH PACKAGING 62584088233 TRAZODONE 50MG TABLET 46241 TRAZODONE HCL AMERICAN HEALTH PACKAGING 62584088301 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL AMERICAN HEALTH PACKAGING 62584088333 TRAZODONE 100MG TABLET 46242 TRAZODONE HCL AMERICAN HEALTH PACKAGING 62584089401 VALPROIC ACID 250MG CAPSULE 4536 VALPROIC ACID AMERICAN HEALTH PACKAGING 62584089601 THIORIDAZINE 100MG TABLET 3860 THIORIDAZINE HCL AMERICAN HEALTH PACKAGING 62584089801 LOXAPINE SUCCINATE 5 MG CAP 3983 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62584089811 LOXAPINE SUCCINATE 5 MG CAP 3983 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62584089901 LOXAPINE SUCCINATE 10 MG CAP 3981 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62584089911 LOXAPINE SUCCINATE 10 MG CAP 3981 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62584090201 LOXAPINE SUCCINATE 25 MG CAP 3982 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62584090211 LOXAPINE SUCCINATE 25 MG CAP 3982 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62584090301 LOXAPINE SUCCINATE 50 MG CAP 3984 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62584090311 LOXAPINE SUCCINATE 50 MG CAP 3984 LOXAPINE SUCCINATE AMERICAN HEALTH PACKAGING 62756043018 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE SUN PHARMACEUTICAL INDUSTRIES, LTD 62756043088 LITHIUM CARBONATE 300 MG TAB 4003 LITHIUM CARBONATE SUN PHARMACEUTICAL INDUSTRIES, LTD 62756075164 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE SUN PHARMACEUTICAL INDUSTRIES, LTD 62756075464 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE SUN PHARMACEUTICAL INDUSTRIES, LTD 62756075564 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE SUN PHARMACEUTICAL INDUSTRIES, LTD 62756075764 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE SUN PHARMACEUTICAL INDUSTRIES, LTD 62756079613 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM SUN PHARMACEUTICAL INDUSTRIES, LTD 62756079688 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM SUN PHARMACEUTICAL INDUSTRIES, LTD 62756079713 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM SUN PHARMACEUTICAL INDUSTRIES, LTD 62756079788 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM SUN PHARMACEUTICAL INDUSTRIES, LTD 62756079813 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM SUN PHARMACEUTICAL INDUSTRIES, LTD 62756079888 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM SUN PHARMACEUTICAL INDUSTRIES, LTD 63252112605 FLUPHENAZINE DEC 25MG/ML VL 3818 FLUPHENAZINE DECANOATE RADFORD THERAPEUTICS 63304016430 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63304016501 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63304016505 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63304016530 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63304016601 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63304016605 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63304016630 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63304020201 NORTRIPTYLINE 10 MG/5 ML SOL 46063 NORTRIPTYLINE HCL RANBAXY PHARMACEUTICALS, INC. 63304050001 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL RANBAXY PHARMACEUTICALS, INC. 63304050005 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL RANBAXY PHARMACEUTICALS, INC. 63304050101 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL RANBAXY PHARMACEUTICALS, INC. 63304050105 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL RANBAXY PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 327 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63304050205 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL RANBAXY PHARMACEUTICALS, INC. 63304050228 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL RANBAXY PHARMACEUTICALS, INC. 63304050260 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054101 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054160 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054201 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054260 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054301 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054360 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054401 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054460 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054501 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304054560 NEFAZODONE HCL 250 MG TABLET 46257 NEFAZODONE HCL RANBAXY PHARMACEUTICALS, INC. 63304055201 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM RANBAXY PHARMACEUTICALS, INC. 63304055205 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM RANBAXY PHARMACEUTICALS, INC. 63304055301 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM RANBAXY PHARMACEUTICALS, INC. 63304055305 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM RANBAXY PHARMACEUTICALS, INC. 63304055401 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM RANBAXY PHARMACEUTICALS, INC. 63304063201 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL RANBAXY PHARMACEUTICALS, INC. 63304063230 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL RANBAXY PHARMACEUTICALS, INC. 63304063290 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL RANBAXY PHARMACEUTICALS, INC. 63304068630 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL RANBAXY PHARMACEUTICALS, INC. 63304068690 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL RANBAXY PHARMACEUTICALS, INC. 63304068730 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL RANBAXY PHARMACEUTICALS, INC. 63304068790 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL RANBAXY PHARMACEUTICALS, INC. 63304077201 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077205 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077290 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077301 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077305 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077310 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077390 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077401 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077405 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304077490 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM RANBAXY PHARMACEUTICALS, INC. 63304084005 SERTRALINE 20 MG/ML ORAL CONC 46230 SERTRALINE HCL RANBAXY PHARMACEUTICALS, INC. 63323027205 FLUPHENAZINE DEC 25 MG/ML VL 3818 FLUPHENAZINE DECANOATE APP PHARMACEUTICALS, LLC. 63323027255 FLUPHENAZINE DEC 25 MG/ML VL 3818 FLUPHENAZINE DECANOATE APP PHARMACEUTICALS, LLC. 63323028110 FLUPHENAZINE 2.5 MG/ML VIAL 3820 FLUPHENAZINE HCL APP PHARMACEUTICALS, LLC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 328 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63323046901 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE APP PHARMACEUTICALS, LLC. 63323046905 HALOPERIDOL DEC 50 MG/ML VIAL 3967 HALOPERIDOL DECANOATE APP PHARMACEUTICALS, LLC. 63323046951 HALOPERIDOL DEC 50 MG/ML VL 3967 HALOPERIDOL DECANOATE APP PHARMACEUTICALS, LLC. 63323047101 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE APP PHARMACEUTICALS, LLC. 63323047105 HALOPERIDOL DEC 100 MG/ML VIAL 11876 HALOPERIDOL DECANOATE APP PHARMACEUTICALS, LLC. 63323047151 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE APP PHARMACEUTICALS, LLC. 63323047155 HALOPERIDOL DEC 100 MG/ML VL 11876 HALOPERIDOL DECANOATE APP PHARMACEUTICALS, LLC. 63323047401 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE APP PHARMACEUTICALS, LLC. 63323047410 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE APP PHARMACEUTICALS, LLC. 63323047491 HALOPERIDOL LAC 5 MG/ML VIAL 3970 HALOPERIDOL LACTATE APP PHARMACEUTICALS, LLC. 63323049405 VALPROATE SOD 500 MG/5 ML VL 31533 VALPROATE SODIUM APP PHARMACEUTICALS, LLC. 63402030230 LATUDA 20 MG TABLET 68448 LURASIDONE HCL SUNOVION PHARMACEUTICALS, INC. 63402030410 LATUDA 40 MG TABLET 66932 LURASIDONE HCL SUNOVION PHARMACEUTICALS, INC. 63402030430 LATUDA 40 MG TABLET 66932 LURASIDONE HCL SUNOVION PHARMACEUTICALS, INC. 63402030810 LATUDA 80 MG TABLET 66933 LURASIDONE HCL SUNOVION PHARMACEUTICALS, INC. 63402030830 LATUDA 80 MG TABLET 66933 LURASIDONE HCL SUNOVION PHARMACEUTICALS, INC. 63459010001 PROVIGIL 100 MG TABLET 25848 MODAFINIL CEPHALON, INC. 63459010101 PROVIGIL 100 MG TABLET 25848 MODAFINIL CEPHALON, INC. 63459010130 PROVIGIL 100 MG TABLET 25848 MODAFINIL CEPHALON, INC. 63459020001 PROVIGIL 200 MG TABLET 41478 MODAFINIL CEPHALON, INC. 63459020101 PROVIGIL 200 MG TABLET 41478 MODAFINIL CEPHALON, INC. 63459020130 PROVIGIL 200 MG TABLET 41478 MODAFINIL CEPHALON, INC. 63459020530 NUVIGIL 50 MG TABLET 62820 ARMODAFINIL CEPHALON, INC. 63459020560 NUVIGIL 50 MG TABLET 62820 ARMODAFINIL CEPHALON, INC. 63459021530 NUVIGIL 150 MG TABLET 62819 ARMODAFINIL CEPHALON, INC. 63459021560 NUVIGIL 150 MG TABLET 62819 ARMODAFINIL CEPHALON, INC. 63459022530 NUVIGIL 250 MG TABLET 62821 ARMODAFINIL CEPHALON, INC. 63459022560 NUVIGIL 250 MG TABLET 62821 ARMODAFINIL CEPHALON, INC. 63481007270 MOBAN 5 MG TABLET 3990 MOLINDONE HCL ENDO PHARMACEUTICALS, INC. 63481007370 MOBAN 10 MG TABLET 3987 MOLINDONE HCL ENDO PHARMACEUTICALS, INC. 63481007470 MOBAN 25 MG TABLET 3989 MOLINDONE HCL ENDO PHARMACEUTICALS, INC. 63481007670 MOBAN 50 MG TABLET 3991 MOLINDONE HCL ENDO PHARMACEUTICALS, INC. 63481007770 MOBAN 100MG TABLET 3988 MOLINDONE HCL ENDO PHARMACEUTICALS, INC. 63481046004 MOBAN 20MG/ML ORAL CONC 3986 MOLINDONE HCL ENDO PHARMACEUTICALS, INC. 63629123300 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629123301 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629123303 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629123304 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629123305 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 329 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63629123306 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629123307 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629123308 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629123309 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 63629131801 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 63629131802 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 63629136801 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136802 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136803 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136804 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136805 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136900 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136901 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136902 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136903 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136904 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136905 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136906 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136907 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136908 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629136909 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629137001 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629137002 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629137003 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629137004 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629151001 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 63629151002 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 63629151003 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 63629151301 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 63629151302 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 63629151303 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 63629151304 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 63629151305 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 63629152301 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 63629152302 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 63629152303 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 63629152304 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 63629152305 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 63629152306 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 330 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63629152307 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 63629152308 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 63629152401 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152402 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152403 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152404 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152405 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152406 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152407 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152408 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629152409 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629154101 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 63629154102 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 63629154103 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 63629154104 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 63629154105 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 63629154106 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 63629154107 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 63629160901 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 63629160902 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 63629160903 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 63629160904 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 63629161001 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 63629161002 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 63629161003 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 63629161004 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 63629161101 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 63629161102 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 63629161103 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 63629161104 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 63629174701 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 63629174702 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 63629174703 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 63629174704 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 63629184001 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 63629184002 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 63629275601 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL LABELER NOT ON FILE 63629283302 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629283304 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 331 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63629283305 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629283306 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629283307 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629286701 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 63629286702 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 63629286703 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 63629294200 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294201 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294202 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294203 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294204 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294205 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294206 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294207 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294208 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294209 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 63629294801 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 63629294802 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 63629294803 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 63629294804 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 63629295301 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 63629295302 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 63629295303 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 63629295304 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 63629295305 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 63629295306 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 63629295401 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 63629295402 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 63629295403 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 63629295404 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 63629295501 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 63629295502 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 63629295503 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 63629295504 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 63629295505 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 63629295506 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 63629295507 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 63629298101 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 63629304701 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 332 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63629304702 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 63629304703 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 63629304704 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 63629319701 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 63629319702 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 63629319703 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 63629320401 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629320402 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629320403 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629320404 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629320501 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 63629320502 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 63629320503 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 63629321001 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 63629321002 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 63629321003 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 63629321004 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 63629323301 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 63629323302 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 63629323303 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 63629323304 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 63629328901 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 63629328902 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 63629328903 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 63629328904 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 63629329101 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629329102 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629330801 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 63629330802 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 63629330803 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 63629330804 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 63629330901 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 63629330902 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 63629330903 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 63629330904 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 63629330905 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 63629331301 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 63629331302 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 63629331303 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 333 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63629331304 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 63629331401 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 63629331402 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 63629331403 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 63629331503 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 63629331601 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 63629331701 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 63629331801 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 63629331802 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 63629331901 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629331902 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629331903 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629332401 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 63629332402 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 63629332403 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 63629332601 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 63629333201 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL LABELER NOT ON FILE 63629333202 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL LABELER NOT ON FILE 63629333203 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL LABELER NOT ON FILE 63629333301 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL LABELER NOT ON FILE 63629333302 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL LABELER NOT ON FILE 63629333801 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 63629333802 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 63629333803 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 63629334001 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 63629334002 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 63629334003 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 63629334501 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 63629334502 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 63629334503 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 63629334601 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE LABELER NOT ON FILE 63629334801 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 63629334802 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 63629334803 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 63629334804 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 63629334901 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 63629335501 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 63629335502 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 63629336201 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 334 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63629336202 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629336203 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629336204 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629337001 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 63629337002 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 63629337003 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 63629337801 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337802 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337803 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337804 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337805 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337901 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337902 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337903 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629337904 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629338001 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629338002 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629338003 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629338004 SEROQUEL 50 MG TABLET 60292 QUETIAPINE FUMARATE LABELER NOT ON FILE 63629338601 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE LABELER NOT ON FILE 63629338602 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE LABELER NOT ON FILE 63629338603 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE LABELER NOT ON FILE 63629338604 ABILIFY 2 MG TABLET 60225 ARIPIPRAZOLE LABELER NOT ON FILE 63629338701 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 63629338702 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 63629338703 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 63629338704 ABILIFY 5 MG TABLET 52898 ARIPIPRAZOLE LABELER NOT ON FILE 63629338801 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 63629338802 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 63629338803 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 63629338804 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 63629344901 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 63629344902 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 63629359701 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629359702 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 63629363301 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE LABELER NOT ON FILE 63629364501 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 63629364502 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 63629364601 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 335 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63629364602 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 63629364603 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 63629376201 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 63629376202 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 63629385801 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 63629385802 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 63629385901 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 63629385902 CLORAZEPATE 15 MG TABLET 3744 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 63629399001 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL LABELER NOT ON FILE 63629399002 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL LABELER NOT ON FILE 63629402701 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 63629402702 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 63629406101 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM LABELER NOT ON FILE 63629406102 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM LABELER NOT ON FILE 63629412301 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL LABELER NOT ON FILE 63629412302 CLOMIPRAMINE 50 MG CAPSULE 46121 CLOMIPRAMINE HCL LABELER NOT ON FILE 63629412501 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE LABELER NOT ON FILE 63629414801 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 63629414802 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 63629414803 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 63629414804 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 63629416901 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 63629416902 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 63629416903 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 63629427601 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629427602 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 63629427801 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 63629427802 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 63629427803 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 63629444201 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 63629453401 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL LABELER NOT ON FILE 63629453402 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL LABELER NOT ON FILE 63629462001 OLANZAPINE 2.5 MG TABLET 29077 OLANZAPINE LABELER NOT ON FILE 63672102502 FLUVOXAMINE MALEATE 25 MG TAB 46208 FLUVOXAMINE MALEATE SYNTHON PHARMACEUTICALS, LTD. 63672105002 FLUVOXAMINE MALEATE 50 MG TAB 46209 FLUVOXAMINE MALEATE SYNTHON PHARMACEUTICALS, LTD. 63672110002 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE SYNTHON PHARMACEUTICALS, LTD. 63672201001 PEXEVA 10 MG TABLET 53387 PAROXETINE MESYLATE SYNTHON PHARMACEUTICALS, LTD. 63672202001 PEXEVA 20 MG TABLET 53388 PAROXETINE MESYLATE SYNTHON PHARMACEUTICALS, LTD. 63672203001 PEXEVA 30 MG TABLET 53389 PAROXETINE MESYLATE SYNTHON PHARMACEUTICALS, LTD.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 336 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63672204001 PEXEVA 40 MG TABLET 53390 PAROXETINE MESYLATE SYNTHON PHARMACEUTICALS, LTD. 63739001001 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001002 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001003 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001010 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001015 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001101 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001103 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001110 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001115 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001201 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001202 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001203 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001210 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739001215 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007201 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007202 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007203 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007301 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007302 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007303 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007310 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007401 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007402 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739007403 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739009301 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739009302 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739009303 DOXEPIN 25MG CAPSULE 46089 DOXEPIN HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739009401 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739009402 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739009403 DOXEPIN 50MG CAPSULE 46090 DOXEPIN HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739012001 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012002 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012003 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012010 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012015 HALOPERIDOL 0.5 MG TABLET 3972 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012101 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012102 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012103 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 337 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63739012110 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012115 HALOPERIDOL 1 MG TABLET 3973 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012201 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012202 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012203 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012210 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012215 HALOPERIDOL 2 MG TABLET 3975 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012301 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012302 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012303 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012310 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739012315 HALOPERIDOL 5 MG TABLET 3977 HALOPERIDOL MCKESSON PACKAGING SERVICE, A DIVISION 63739015401 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015403 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015410 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015415 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015501 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015503 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015510 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015515 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015601 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015603 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015610 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739015615 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739018901 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739018902 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739018903 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739018910 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739018915 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739019001 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739019003 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739019010 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739019015 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024501 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024503 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024510 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024515 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024601 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024602 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 338 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63739024603 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024610 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739024615 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739025101 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID MCKESSON PACKAGING SERVICE, A DIVISION 63739025102 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID MCKESSON PACKAGING SERVICE, A DIVISION 63739025103 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID MCKESSON PACKAGING SERVICE, A DIVISION 63739025110 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID MCKESSON PACKAGING SERVICE, A DIVISION 63739025115 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID MCKESSON PACKAGING SERVICE, A DIVISION 63739026501 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE MCKESSON PACKAGING SERVICE, A DIVISION 63739026503 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE MCKESSON PACKAGING SERVICE, A DIVISION 63739026510 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE MCKESSON PACKAGING SERVICE, A DIVISION 63739026515 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE MCKESSON PACKAGING SERVICE, A DIVISION 63739029510 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739029515 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739029610 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739029615 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031710 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031715 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031810 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031815 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031901 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031903 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031910 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739031915 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739032001 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739032003 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739032010 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739032015 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739035504 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE MCKESSON PACKAGING SERVICE, A DIVISION 63739035510 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE MCKESSON PACKAGING SERVICE, A DIVISION 63739035515 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE MCKESSON PACKAGING SERVICE, A DIVISION 63739035610 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE MCKESSON PACKAGING SERVICE, A DIVISION 63739035615 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE MCKESSON PACKAGING SERVICE, A DIVISION 63739040710 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739040810 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739044810 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE MCKESSON PACKAGING SERVICE, A DIVISION 63739044910 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739045010 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL MCKESSON PACKAGING SERVICE, A DIVISION 63739049904 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 339 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63739049910 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739050004 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739050010 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739050110 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON PACKAGING SERVICE, A DIVISION 63739051610 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE MCKESSON PACKAGING SERVICE, A DIVISION 63739051710 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE MCKESSON PACKAGING SERVICE, A DIVISION 63739054610 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE MCKESSON PACKAGING SERVICE, A DIVISION 63739054710 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE MCKESSON PACKAGING SERVICE, A DIVISION 63739055310 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM MCKESSON PACKAGING SERVICE, A DIVISION 63739055410 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM MCKESSON PACKAGING SERVICE, A DIVISION 63857032710 SERAX 10 MG CAPSULE 3769 OXAZEPAM ALPHARMA BRANDED PRODUCTS DIVISION, INC 63857032810 SERAX 15 MG CAPSULE 3770 OXAZEPAM ALPHARMA BRANDED PRODUCTS DIVISION, INC 63857032910 SERAX 30 MG CAPSULE 3771 OXAZEPAM ALPHARMA BRANDED PRODUCTS DIVISION, INC 63857033210 SERAX 15 MG TABLET 3772 OXAZEPAM ALPHARMA BRANDED PRODUCTS DIVISION, INC 63874020501 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020504 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020506 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020510 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020512 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020515 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020520 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020530 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020550 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020560 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020572 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020574 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020577 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020590 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM CARDINAL PHARMA 63874020701 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020704 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020712 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020715 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020720 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020730 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020760 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020772 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020774 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020777 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA 63874020790 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 340 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874020801 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874020810 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874020815 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874020820 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874020830 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874020836 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874020860 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874020890 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM CARDINAL PHARMA 63874022601 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022604 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022610 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022612 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022615 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022620 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022628 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022630 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022660 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022690 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM CARDINAL PHARMA 63874022701 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022704 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022705 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022706 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022708 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022709 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022710 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022712 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022714 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022715 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022716 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022718 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022720 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022721 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022724 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022728 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022730 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022736 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022740 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022750 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022760 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 341 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874022772 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022774 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022777 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022787 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022790 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM CARDINAL PHARMA 63874022801 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022804 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022806 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022809 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022810 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022812 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022815 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022820 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022828 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022830 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022840 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022860 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022872 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022874 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022877 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874022890 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM CARDINAL PHARMA 63874025101 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025110 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025112 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025114 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025115 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025120 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025130 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025160 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025172 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025174 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025177 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025190 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM CARDINAL PHARMA 63874025201 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025204 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025206 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025209 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025210 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025212 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 342 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874025214 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025215 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025218 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025220 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025224 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025230 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025250 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025260 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025272 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025274 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025277 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025290 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM CARDINAL PHARMA 63874025301 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025304 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025310 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025312 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025314 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025315 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025318 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025320 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025321 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025324 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025325 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025328 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025330 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025340 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025350 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025360 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025372 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025374 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874025377 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM CARDINAL PHARMA 63874029601 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA 63874029604 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA 63874029615 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA 63874029620 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA 63874029630 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA 63874029640 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA 63874029660 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA 63874029690 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 343 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874031101 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031104 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031110 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031112 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031115 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031120 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031124 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031130 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031140 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031150 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031160 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031172 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031174 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031177 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874031190 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035901 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035904 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035914 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035915 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035920 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035928 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035930 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035940 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035950 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035960 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874035990 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043001 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043004 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043014 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043015 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043020 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043025 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043028 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043030 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043040 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043050 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043060 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874043090 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL CARDINAL PHARMA 63874053701 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 344 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874053704 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053710 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053712 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053714 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053715 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053720 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053730 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053760 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053790 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL CARDINAL PHARMA 63874053801 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARDINAL PHARMA 63874053810 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARDINAL PHARMA 63874053814 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARDINAL PHARMA 63874053815 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARDINAL PHARMA 63874053820 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARDINAL PHARMA 63874053830 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARDINAL PHARMA 63874053860 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL CARDINAL PHARMA 63874055501 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL CARDINAL PHARMA 63874055510 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL CARDINAL PHARMA 63874055514 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL CARDINAL PHARMA 63874055515 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL CARDINAL PHARMA 63874055520 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL CARDINAL PHARMA 63874055530 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL CARDINAL PHARMA 63874055560 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL CARDINAL PHARMA 63874056001 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056004 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056010 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056012 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056014 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056015 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056020 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056028 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056030 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056040 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056060 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056090 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL CARDINAL PHARMA 63874056701 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056704 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056720 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056728 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 345 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874056730 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056740 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056750 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056760 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056770 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056772 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056774 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056777 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056780 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874056790 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL CARDINAL PHARMA 63874057301 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057304 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057310 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057314 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057315 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057320 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057321 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057328 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057330 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057360 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057372 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057374 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057377 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057390 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL CARDINAL PHARMA 63874057401 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057404 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057410 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057414 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057420 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057421 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057428 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057430 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057460 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057472 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057474 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057477 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874057490 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL CARDINAL PHARMA 63874058001 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL CARDINAL PHARMA 63874058014 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 346 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874058015 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL CARDINAL PHARMA 63874058020 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL CARDINAL PHARMA 63874058030 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL CARDINAL PHARMA 63874058060 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL CARDINAL PHARMA 63874058090 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL CARDINAL PHARMA 63874059601 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL CARDINAL PHARMA 63874059610 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL CARDINAL PHARMA 63874059614 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL CARDINAL PHARMA 63874059615 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL CARDINAL PHARMA 63874059620 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL CARDINAL PHARMA 63874059630 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL CARDINAL PHARMA 63874059660 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL CARDINAL PHARMA 63874059901 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059910 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059914 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059915 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059920 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059921 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059928 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059930 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059940 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059950 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059960 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874059990 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL CARDINAL PHARMA 63874061601 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061604 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061610 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061612 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061615 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061620 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061625 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061628 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061630 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061640 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061650 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061660 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061670 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061672 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061674 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 347 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874061677 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061680 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874061690 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL CARDINAL PHARMA 63874077501 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL CARDINAL PHARMA 63874077512 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL CARDINAL PHARMA 63874077515 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL CARDINAL PHARMA 63874077520 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL CARDINAL PHARMA 63874077530 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL CARDINAL PHARMA 63874077560 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL CARDINAL PHARMA 63874082801 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082804 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082814 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082820 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082821 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082828 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082830 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082860 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082890 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL CARDINAL PHARMA 63874082901 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082910 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082914 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082915 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082920 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082928 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082930 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082942 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082950 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874082960 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL CARDINAL PHARMA 63874100901 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE CARDINAL PHARMA 63874100903 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE CARDINAL PHARMA 63874100906 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE CARDINAL PHARMA 63874100909 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE CARDINAL PHARMA 63874101601 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA 63874101602 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA 63874101603 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA 63874101604 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA 63874101605 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA 63874101606 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA 63874101608 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 348 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 63874101609 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM CARDINAL PHARMA 63874103301 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL CARDINAL PHARMA 63874103303 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL CARDINAL PHARMA 63874103304 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL CARDINAL PHARMA 63874103306 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL CARDINAL PHARMA 63874105301 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105302 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105303 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105304 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105305 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105306 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105308 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105309 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL CARDINAL PHARMA 63874105405 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL CARDINAL PHARMA 63874107906 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL CARDINAL PHARMA 63874108003 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL CARDINAL PHARMA 63874108006 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL CARDINAL PHARMA 63874108101 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL CARDINAL PHARMA 63874108106 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL CARDINAL PHARMA 63874109703 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE CARDINAL PHARMA 63874109803 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE CARDINAL PHARMA 63874111301 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874111303 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874111306 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874112506 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL CARDINAL PHARMA 63874113006 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL CARDINAL PHARMA 63874114601 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874114603 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874114606 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874115103 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL CARDINAL PHARMA 63874115503 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE CARDINAL PHARMA 63874115700 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874115703 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE CARDINAL PHARMA 63874123903 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM CARDINAL PHARMA 63874123906 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM CARDINAL PHARMA 64125090401 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64125090405 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64125090410 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64125090501 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 349 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 64125090505 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64125090510 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64125090601 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64125090605 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64125090610 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM EXCELLIUM PHARMACEUTICAL, INC. 64376040340 HALOPERIDOL LAC 2MG/ML CONC 3971 HALOPERIDOL LACTATE BOCA PHARMACAL, INC. 64376063001 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063005 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063010 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063101 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063105 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063110 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063201 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063205 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063210 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063301 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM BOCA PHARMACAL, INC. 64376063305 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM BOCA PHARMACAL, INC. 64455006301 ATIVAN 0.5 MG TABLET 3757 LORAZEPAM BTA PHARMACEUTICALS, INC. 64455006401 ATIVAN 1 MG TABLET 3758 LORAZEPAM BTA PHARMACEUTICALS, INC. 64455006410 ATIVAN 1 MG TABLET 3758 LORAZEPAM BTA PHARMACEUTICALS, INC. 64455006501 ATIVAN 2 MG TABLET 3759 LORAZEPAM BTA PHARMACEUTICALS, INC. 64455073030 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL BTA PHARMACEUTICALS, INC. 64455073090 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL BTA PHARMACEUTICALS, INC. 64455073130 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL BTA PHARMACEUTICALS, INC. 64597010110 FAZACLO 12.5 MG TABLET 63031 CLOZAPINE AVANIR PHARMACEUTICALS, INC. 64597010210 FAZACLO 25 MG TABLET 53994 CLOZAPINE AVANIR PHARMACEUTICALS, INC. 64597010410 FAZACLO 100 MG TABLET 53995 CLOZAPINE AVANIR PHARMACEUTICALS, INC. 64679055302 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055304 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055402 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055404 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055502 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055504 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055702 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055704 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679055901 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE WOCKHARDT AMERICAS, INC. 64679056001 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE WOCKHARDT AMERICAS, INC. 64679056101 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE WOCKHARDT AMERICAS, INC. 64679057102 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE WOCKHARDT AMERICAS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 350 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 64679057104 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679057202 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679057204 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679069201 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE WOCKHARDT AMERICAS, INC. 64679071601 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071604 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071605 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071701 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071704 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071705 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071801 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071804 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679071805 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL WOCKHARDT AMERICAS, INC. 64679072401 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679072402 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679072403 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679072501 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679072502 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679072503 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679075201 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WOCKHARDT AMERICAS, INC. 64679075204 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WOCKHARDT AMERICAS, INC. 64679075207 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL WOCKHARDT AMERICAS, INC. 64679075301 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WOCKHARDT AMERICAS, INC. 64679075304 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WOCKHARDT AMERICAS, INC. 64679075307 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL WOCKHARDT AMERICAS, INC. 64679096911 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE WOCKHARDT AMERICAS, INC. 64679096914 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE WOCKHARDT AMERICAS, INC. 64679097011 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE WOCKHARDT AMERICAS, INC. 64679097014 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE WOCKHARDT AMERICAS, INC. 64679097111 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE WOCKHARDT AMERICAS, INC. 64679097114 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE WOCKHARDT AMERICAS, INC. 64679097301 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679097401 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679097402 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679097501 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64679097502 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM WOCKHARDT AMERICAS, INC. 64720017003 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA 64720017010 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA 64720017103 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 351 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 64720017110 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA 64720017111 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA 64720017203 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA 64720017210 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA 64720017211 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AURIGA LABORATORIES, CORE PHARMA 64803003201 MARPLAN 10 MG TABLET 46262 ISOCARBOXAZID OXFORD PHARMACEUTICAL SERVICES 64915075060 ST. JOHN'S WORT 450 MG CAP 46335 ST. JOHN'S WORT LABELER NOT ON FILE 64980014006 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM RISING PHARMACEUTICALS, INC. 64980014106 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM RISING PHARMACEUTICALS, INC. 64980014206 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM RISING PHARMACEUTICALS, INC. 64980014306 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM RISING PHARMACEUTICALS, INC. 64980015801 PROTRIPTYLINE HCL 5 MG TABLET 46080 PROTRIPTYLINE HCL RISING PHARMACEUTICALS, INC. 64980015901 PROTRIPTYLINE HCL 10 MG TABLET 46079 PROTRIPTYLINE HCL RISING PHARMACEUTICALS, INC. 65084037314 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON CORP, RX PAK DIVISION 65084037318 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON CORP, RX PAK DIVISION 65084037320 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON CORP, RX PAK DIVISION 65084037336 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL MCKESSON CORP, RX PAK DIVISION 65084044114 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044118 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044120 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044136 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044214 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044218 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044220 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044236 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044314 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044318 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65084044320 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM MCKESSON CORP, RX PAK DIVISION 65162001510 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM AMNEAL PHARMACEUTICALS LLC 65162001550 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM AMNEAL PHARMACEUTICALS LLC 65162001710 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM AMNEAL PHARMACEUTICALS LLC 65162001750 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM AMNEAL PHARMACEUTICALS LLC 65162001810 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM AMNEAL PHARMACEUTICALS LLC 65162001850 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM AMNEAL PHARMACEUTICALS LLC 65162005210 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AMNEAL PHARMACEUTICALS LLC 65162005250 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AMNEAL PHARMACEUTICALS LLC 65162005310 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AMNEAL PHARMACEUTICALS LLC 65162005350 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AMNEAL PHARMACEUTICALS LLC 65162005403 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AMNEAL PHARMACEUTICALS LLC

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 352 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 65162005410 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AMNEAL PHARMACEUTICALS LLC 65162005450 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AMNEAL PHARMACEUTICALS LLC 65162017610 FLUOXETINE 10 MG CAPSULE 46213 FLUOXETINE HCL AMNEAL PHARMACEUTICALS LLC 65162017611 FLUOXETINE 10 MG CAPSULE 46213 FLUOXETINE HCL AMNEAL PHARMACEUTICALS LLC 65162017810 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL AMNEAL PHARMACEUTICALS LLC 65162017811 FLUOXETINE 20 MG CAPSULE 46214 FLUOXETINE HCL AMNEAL PHARMACEUTICALS LLC 65162030009 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL AMNEAL PHARMACEUTICALS LLC 65162030209 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL AMNEAL PHARMACEUTICALS LLC 65162030509 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL AMNEAL PHARMACEUTICALS LLC 65162030609 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL AMNEAL PHARMACEUTICALS LLC 65162030709 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL AMNEAL PHARMACEUTICALS LLC 65162067384 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE AMNEAL PHARMACEUTICALS LLC 65162068784 LORAZEPAM 2 MG/ML ORAL CONCENT 16363 LORAZEPAM AMNEAL PHARMACEUTICALS LLC 65162070588 ESCITALOPRAM OXALATE 5 MG/5 ML 51698 ESCITALOPRAM OXALATE AMNEAL PHARMACEUTICALS LLC 65162080906 ALPRAZOLAM ER 0.5 MG TABLET 50399 ALPRAZOLAM AMNEAL PHARMACEUTICALS LLC 65162081006 ALPRAZOLAM ER 1 MG TABLET 50400 ALPRAZOLAM AMNEAL PHARMACEUTICALS LLC 65162081206 ALPRAZOLAM ER 2 MG TABLET 50401 ALPRAZOLAM AMNEAL PHARMACEUTICALS LLC 65162081306 ALPRAZOLAM ER 3 MG TABLET 52143 ALPRAZOLAM AMNEAL PHARMACEUTICALS LLC 65243000603 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL VA CMOP, DALLAS 65243000609 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL VA CMOP, DALLAS 65243006303 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL VA CMOP, DALLAS 65243006306 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL VA CMOP, DALLAS 65243006309 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL VA CMOP, DALLAS 65243006315 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL VA CMOP, DALLAS 65243006318 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL VA CMOP, DALLAS 65243006345 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL VA CMOP, DALLAS 65243013803 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM VA CMOP, DALLAS 65243013806 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM VA CMOP, DALLAS 65243013809 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM VA CMOP, DALLAS 65243013812 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM VA CMOP, DALLAS 65243016203 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243017203 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM VA CMOP, DALLAS 65243017206 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM VA CMOP, DALLAS 65243017209 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM VA CMOP, DALLAS 65243017212 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM VA CMOP, DALLAS 65243018203 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM VA CMOP, DALLAS 65243018206 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM VA CMOP, DALLAS 65243018703 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM VA CMOP, DALLAS 65243018706 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM VA CMOP, DALLAS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 353 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 65243018709 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM VA CMOP, DALLAS 65243018712 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM VA CMOP, DALLAS 65243019803 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM VA CMOP, DALLAS 65243019806 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM VA CMOP, DALLAS 65243019809 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM VA CMOP, DALLAS 65243019812 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM VA CMOP, DALLAS 65243019903 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM VA CMOP, DALLAS 65243019906 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM VA CMOP, DALLAS 65243019909 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM VA CMOP, DALLAS 65243020403 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL VA CMOP, DALLAS 65243020406 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL VA CMOP, DALLAS 65243020409 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL VA CMOP, DALLAS 65243020412 CHLORDIAZEPOXIDE 10 MG CAP 3734 CHLORDIAZEPOXIDE HCL VA CMOP, DALLAS 65243021103 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243021109 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243023803 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM VA CMOP, DALLAS 65243023806 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM VA CMOP, DALLAS 65243023809 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM VA CMOP, DALLAS 65243023812 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM VA CMOP, DALLAS 65243024203 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL VA CMOP, DALLAS 65243024209 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL VA CMOP, DALLAS 65243024409 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL VA CMOP, DALLAS 65243026845 PAROXETINE HCL 40 MG 46225 PAROXETINE HCL VA CMOP, DALLAS 65243027009 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL VA CMOP, DALLAS 65243029503 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM VA CMOP, DALLAS 65243029506 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM VA CMOP, DALLAS 65243029509 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM VA CMOP, DALLAS 65243029512 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM VA CMOP, DALLAS 65243029518 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM VA CMOP, DALLAS 65243029703 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM VA CMOP, DALLAS 65243029706 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM VA CMOP, DALLAS 65243030203 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243030209 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243031003 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243031009 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243031015 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243031045 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243031903 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243031909 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 354 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 65243031945 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243032703 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VA CMOP, DALLAS 65243032706 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VA CMOP, DALLAS 65243032709 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VA CMOP, DALLAS 65243033309 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL VA CMOP, DALLAS 65243033603 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL VA CMOP, DALLAS 65243033606 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL VA CMOP, DALLAS 65243033609 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL VA CMOP, DALLAS 65243035106 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL VA CMOP, DALLAS 65243035415 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL VA CMOP, DALLAS 65243035909 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL VA CMOP, DALLAS 65243038109 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243038145 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243038409 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243038445 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE VA CMOP, DALLAS 65243038603 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VA CMOP, DALLAS 65243038606 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VA CMOP, DALLAS 65243038609 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL VA CMOP, DALLAS 65473070101 VIVACTIL 5 MG TABLET 46080 PROTRIPTYLINE HCL ODYSSEY PHARMACEUTICAL, INC. 65473070201 VIVACTIL 10 MG TABLET 46079 PROTRIPTYLINE HCL ODYSSEY PHARMACEUTICAL, INC. 65473071801 SURMONTIL 25 MG CAPSULE 46112 TRIMIPRAMINE MALEATE ODYSSEY PHARMACEUTICAL, INC. 65473071901 SURMONTIL 50 MG CAPSULE 46113 TRIMIPRAMINE MALEATE ODYSSEY PHARMACEUTICAL, INC. 65473072001 SURMONTIL 100 MG CAPSULE 46111 TRIMIPRAMINE MALEATE ODYSSEY PHARMACEUTICAL, INC. 65580030103 VENLAFAXINE HCL ER 37.5 MG TAB 64444 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65580030109 VENLAFAXINE HCL ER 37.5 MG TAB 64444 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65580030203 VENLAFAXINE HCL ER 75 MG TAB 64445 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65580030209 VENLAFAXINE HCL ER 75 MG TAB 64445 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65580030303 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65580030309 VENLAFAXINE HCL ER 150 MG TAB 64446 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65580030403 VENLAFAXINE HCL ER 225 MG TAB 64447 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65580030409 VENLAFAXINE HCL ER 225 MG TAB 64447 VENLAFAXINE HCL UPSTATE PHARMA, LLC 65862000101 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862000105 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862000130 MIRTAZAPINE 7.5 MG TABLET 54009 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862000301 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862000303 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862000305 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862000330 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862000390 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AUROBINDO PHARMA LTD.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 355 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 65862000501 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000505 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000510 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000530 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000601 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000605 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000610 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000630 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000701 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000705 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000710 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862000730 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862001101 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001105 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001130 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001190 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001201 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001205 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001230 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001290 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001301 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001305 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001330 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862001390 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL AUROBINDO PHARMA LTD. 65862002106 MIRTAZAPINE 15 MG ODT 47453 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862002206 MIRTAZAPINE 30 MG ODT 47454 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862002306 MIRTAZAPINE 45 MG ODT 47636 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003101 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003103 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003105 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003130 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003190 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003201 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003203 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003205 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003230 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862003290 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AUROBINDO PHARMA LTD. 65862007424 CITALOPRAM HBR 10 MG/5 ML SOLN 46205 CITALOPRAM HYDROBROMIDE AUROBINDO PHARMA LTD. 65862011905 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE AUROBINDO PHARMA LTD.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 356 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 65862011960 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE AUROBINDO PHARMA LTD. 65862012005 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE AUROBINDO PHARMA LTD. 65862012060 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE AUROBINDO PHARMA LTD. 65862012105 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE AUROBINDO PHARMA LTD. 65862012160 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE AUROBINDO PHARMA LTD. 65862012205 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE AUROBINDO PHARMA LTD. 65862012260 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE AUROBINDO PHARMA LTD. 65862012305 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE AUROBINDO PHARMA LTD. 65862012360 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE AUROBINDO PHARMA LTD. 65862012460 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE AUROBINDO PHARMA LTD. 65862015430 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862015505 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862015530 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862015599 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862015630 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862015699 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862015730 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862015799 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AUROBINDO PHARMA LTD. 65862016730 RISPERIDONE 1 MG/ML SOLUTION 26177 RISPERIDONE AUROBINDO PHARMA LTD. 65862019201 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862019205 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862019299 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862019301 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862019305 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862019399 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862019401 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862019430 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL AUROBINDO PHARMA LTD. 65862022701 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862022801 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862022901 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862022960 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862023001 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862023060 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862036101 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862036201 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE AUROBINDO PHARMA LTD. 65862040101 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM AUROBINDO PHARMA LTD. 65862040105 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM AUROBINDO PHARMA LTD. 65862040201 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM AUROBINDO PHARMA LTD. 65862040205 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM AUROBINDO PHARMA LTD.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 357 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 65862040301 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM AUROBINDO PHARMA LTD. 65862040305 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM AUROBINDO PHARMA LTD. 65862040401 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040460 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040501 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040560 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040590 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040601 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040630 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040690 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040701 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040730 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040801 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862040820 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052701 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052730 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052790 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052799 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052801 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052830 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052890 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052899 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052930 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862052990 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862069701 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862069705 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862069730 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 65862069790 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AUROBINDO PHARMA LTD. 66105096903 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 66105097703 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 66116023130 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 66116023230 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 66116025330 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 66116025430 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LABELER NOT ON FILE 66116028030 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 66116028107 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 66116028130 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 66116028630 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 66116028640 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 358 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 66116048460 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 66267001330 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM NUCARE PHARM. 66267001360 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM NUCARE PHARM. 66267001390 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM NUCARE PHARM. 66267001430 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM NUCARE PHARM. 66267001460 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM NUCARE PHARM. 66267001490 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM NUCARE PHARM. 66267001491 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM NUCARE PHARM. 66267001830 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL NUCARE PHARM. 66267001860 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL NUCARE PHARM. 66267001890 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL NUCARE PHARM. 66267001914 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL NUCARE PHARM. 66267001930 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL NUCARE PHARM. 66267001960 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL NUCARE PHARM. 66267001990 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL NUCARE PHARM. 66267002030 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL NUCARE PHARM. 66267002060 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL NUCARE PHARM. 66267006802 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM NUCARE PHARM. 66267006815 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM NUCARE PHARM. 66267006830 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM NUCARE PHARM. 66267006845 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM NUCARE PHARM. 66267006860 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM NUCARE PHARM. 66267006890 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM NUCARE PHARM. 66267006891 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM NUCARE PHARM. 66267006903 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006906 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006910 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006915 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006920 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006930 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006960 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006990 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267006991 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM NUCARE PHARM. 66267008430 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL NUCARE PHARM. 66267013330 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM NUCARE PHARM. 66267020530 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL NUCARE PHARM. 66267020560 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL NUCARE PHARM. 66267021930 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM NUCARE PHARM. 66267021960 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM NUCARE PHARM.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 359 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 66267021990 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM NUCARE PHARM. 66267026630 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL NUCARE PHARM. 66267039230 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL NUCARE PHARM. 66267039260 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL NUCARE PHARM. 66267042720 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM NUCARE PHARM. 66267048330 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL NUCARE PHARM. 66267048345 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL NUCARE PHARM. 66267048360 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL NUCARE PHARM. 66267048430 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL NUCARE PHARM. 66267048445 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL NUCARE PHARM. 66267048460 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL NUCARE PHARM. 66267048830 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL NUCARE PHARM. 66267048860 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL NUCARE PHARM. 66267048890 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL NUCARE PHARM. 66267052820 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL NUCARE PHARM. 66267052860 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL NUCARE PHARM. 66267055030 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM NUCARE PHARM. 66267056090 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL NUCARE PHARM. 66267056491 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM NUCARE PHARM. 66267057630 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL NUCARE PHARM. 66267058730 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL NUCARE PHARM. 66267061430 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL NUCARE PHARM. 66267061460 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL NUCARE PHARM. 66267061830 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE NUCARE PHARM. 66267062630 DESIPRAMINE 100 MG TABLET 46104 DESIPRAMINE HCL NUCARE PHARM. 66267068030 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL NUCARE PHARM. 66267072130 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL NUCARE PHARM. 66267100600 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL NUCARE PHARM. 66267130606 XANAX XR 2 MG TABLET 50401 ALPRAZOLAM NUCARE PHARM. 66336000430 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 66336000460 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 66336000490 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 66336001428 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 66336001430 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 66336001460 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 66336002730 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336002760 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336002790 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336003310 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 360 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 66336003330 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 66336003344 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 66336003360 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 66336004708 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 66336004710 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 66336004720 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 66336004730 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 66336005190 DEPAKOTE ER 500 MG TAB SA 46315 DIVALPROEX SODIUM LABELER NOT ON FILE 66336005230 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 66336022430 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336027130 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 66336035430 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336035460 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336036330 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 66336040330 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 66336040360 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 66336040390 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 66336041830 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL LABELER NOT ON FILE 66336047802 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 66336047806 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 66336047810 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 66336047815 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 66336047830 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 66336047860 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 66336051730 FLUOXETINE HCL 10 MG TABLET 46216 FLUOXETINE HCL LABELER NOT ON FILE 66336055330 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 66336062028 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 66336062030 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 66336062060 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 66336062090 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 66336062160 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 66336067330 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336067360 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 66336074230 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE 66336075730 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 66336075760 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 66336079930 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 66336079960 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 66336080030 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 361 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 66336080099 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 66336083814 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 66336083830 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 66336084430 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 66336084490 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 66336086130 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 66336086160 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 66336086190 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 66336087620 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 66336087630 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 66336087660 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 66336089730 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 66336089760 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 66336089790 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 66336093230 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 66336093260 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 66336097130 PROZAC 10 MG TABLET 46216 FLUOXETINE HCL LABELER NOT ON FILE 66336097360 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 66336099330 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 66336099390 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 66689001560 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE VISTAPHARM, INC. 66689001660 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE VISTAPHARM, INC. 66758002001 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PARENTA PHARMACEUTICALS, INC. 66758002002 DIAZEPAM 5 MG/ML VIAL 3763 DIAZEPAM PARENTA PHARMACEUTICALS, INC. 66860010002 HALOPERIDOL LAC 5 MG/ML AMP 3968 HALOPERIDOL LACTATE CURA PHARMACEUTICAL CO., INC. 66993004705 OLANZAPINE 2.5 MG TABLET 29077 OLANZAPINE PRASCO LABORATORIES 66993004730 OLANZAPINE 2.5 MG TABLET 29077 OLANZAPINE PRASCO LABORATORIES 66993004805 OLANZAPINE 5 MG TABLET 27961 OLANZAPINE PRASCO LABORATORIES 66993004830 OLANZAPINE 5 MG TABLET 27961 OLANZAPINE PRASCO LABORATORIES 66993004905 OLANZAPINE 7.5 MG TABLET 27959 OLANZAPINE PRASCO LABORATORIES 66993004930 OLANZAPINE 7.5 MG TABLET 27959 OLANZAPINE PRASCO LABORATORIES 66993005005 OLANZAPINE 10 MG TABLET 27960 OLANZAPINE PRASCO LABORATORIES 66993005030 OLANZAPINE 10 MG TABLET 27960 OLANZAPINE PRASCO LABORATORIES 66993005105 OLANZAPINE 15 MG TABLET 41026 OLANZAPINE PRASCO LABORATORIES 66993005130 OLANZAPINE 15 MG TABLET 41026 OLANZAPINE PRASCO LABORATORIES 66993005205 OLANZAPINE 20 MG TABLET 41027 OLANZAPINE PRASCO LABORATORIES 66993005230 OLANZAPINE 20 MG TABLET 41027 OLANZAPINE PRASCO LABORATORIES 66993005330 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE PRASCO LABORATORIES 66993005381 OLANZAPINE ODT 5 MG TABLET 45190 OLANZAPINE PRASCO LABORATORIES

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 362 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 66993005430 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE PRASCO LABORATORIES 66993005481 OLANZAPINE ODT 10 MG TABLET 45191 OLANZAPINE PRASCO LABORATORIES 66993005530 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE PRASCO LABORATORIES 66993005581 OLANZAPINE ODT 15 MG TABLET 47285 OLANZAPINE PRASCO LABORATORIES 66993005630 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE PRASCO LABORATORIES 66993005681 OLANZAPINE ODT 20 MG TABLET 47286 OLANZAPINE PRASCO LABORATORIES 66993070930 MIRTAZAPINE 15 MG ODT 47453 MIRTAZAPINE PRASCO LABORATORIES 66993071130 MIRTAZAPINE 30 MG ODT 47454 MIRTAZAPINE PRASCO LABORATORIES 66993071230 MIRTAZAPINE 45 MG ODT 47636 MIRTAZAPINE PRASCO LABORATORIES 67253090009 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090010 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090011 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090050 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090110 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090111 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090150 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090210 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090211 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090250 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090310 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM DAVA INTERNATIONAL INC. 67253090350 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM DAVA INTERNATIONAL INC. 67263004530 STRATTERA 25 MG CAPSULE 51491 ATOMOXETINE HCL LABELER NOT ON FILE 67263004630 STRATTERA 40 MG CAPSULE 51492 ATOMOXETINE HCL LABELER NOT ON FILE 67263010901 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 67263013660 CYMBALTA 20 MG CAPSULE 57891 DULOXETINE HCL LABELER NOT ON FILE 67263027901 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL LABELER NOT ON FILE 67263045660 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE LABELER NOT ON FILE 67263049801 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL LABELER NOT ON FILE 67263050560 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL LABELER NOT ON FILE 67263060090 CLOMIPRAMINE 75 MG CAPSULE 46122 CLOMIPRAMINE HCL LABELER NOT ON FILE 67386030101 TRANXENE T-TAB 3.75 MG 3745 CLORAZEPATE DIPOTASSIUM LUNDBECK, INC. 67386030201 TRANXENE T-TAB 7.5 MG 3746 CLORAZEPATE DIPOTASSIUM LUNDBECK, INC. 67386030205 TRANXENE T-TAB 7.5 MG 3746 CLORAZEPATE DIPOTASSIUM LUNDBECK, INC. 67386030301 TRANXENE T-TAB 15 MG 3744 CLORAZEPATE DIPOTASSIUM LUNDBECK, INC. 67386040401 TRANXENE SD 11.25 MG TABLET 3747 CLORAZEPATE DIPOTASSIUM LUNDBECK, INC. 67386040501 TRANXENE SD 22.5 MG TAB 3748 CLORAZEPATE DIPOTASSIUM LUNDBECK, INC. 67544000515 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544000530 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544000545 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 363 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544000553 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544000560 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544000570 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544000580 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544000615 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000620 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000630 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000645 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000653 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000660 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000670 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000675 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000680 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544000715 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000730 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000745 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000753 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000755 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000760 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000770 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000775 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000780 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544000790 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544001330 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544001353 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544001360 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544001365 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544001370 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544001830 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544001853 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544001860 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544001865 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544001875 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544001915 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001920 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001930 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001940 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001945 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001953 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 364 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544001955 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001960 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001970 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001975 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001980 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544001990 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544002015 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002030 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002045 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002053 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002060 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002070 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002075 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002080 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002090 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544002710 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002715 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002720 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002730 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002740 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002745 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002753 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002755 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002760 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002770 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002775 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002780 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002792 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544002815 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544002830 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544002845 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544002853 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544002860 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544002870 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544003615 PROVIGIL 200 MG TABLET 41478 MODAFINIL PREPAK SYSTEMS, 67544003630 PROVIGIL 200 MG TABLET 41478 MODAFINIL PREPAK SYSTEMS, 67544003645 PROVIGIL 200 MG TABLET 41478 MODAFINIL PREPAK SYSTEMS, 67544003653 PROVIGIL 200 MG TABLET 41478 MODAFINIL PREPAK SYSTEMS, 67544003660 PROVIGIL 200 MG TABLET 41478 MODAFINIL PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 365 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544005530 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544005553 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544005560 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544005570 CHLORDIAZEPOXIDE 5 MG CAPSULE 3736 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544005615 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005630 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005645 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005653 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005660 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005670 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005675 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005680 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544005690 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544006315 REMERON 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544006330 REMERON 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544006345 REMERON 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544006353 REMERON 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544006430 ZYPREXA 15 MG TABLET 41026 OLANZAPINE PREPAK SYSTEMS, 67544006715 RISPERDAL 4 MG TABLET 21157 RISPERIDONE PREPAK SYSTEMS, 67544006730 RISPERDAL 4 MG TABLET 21157 RISPERIDONE PREPAK SYSTEMS, 67544006745 RISPERDAL 4 MG TABLET 21157 RISPERIDONE PREPAK SYSTEMS, 67544006748 RISPERDAL 4 MG TABLET 21157 RISPERIDONE PREPAK SYSTEMS, 67544006760 RISPERDAL 4 MG TABLET 21157 RISPERIDONE PREPAK SYSTEMS, 67544006789 RISPERDAL 4 MG TABLET 21157 RISPERIDONE PREPAK SYSTEMS, 67544007830 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PREPAK SYSTEMS, 67544007853 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PREPAK SYSTEMS, 67544007860 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PREPAK SYSTEMS, 67544007870 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PREPAK SYSTEMS, 67544007880 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PREPAK SYSTEMS, 67544007892 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL PREPAK SYSTEMS, 67544008015 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544008030 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544008045 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544008053 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544008060 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544008071 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544008080 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544008530 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544008553 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 366 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544008560 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544008570 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544008575 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544008580 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544011530 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544011553 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544011560 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544011630 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PREPAK SYSTEMS, 67544011653 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PREPAK SYSTEMS, 67544011660 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PREPAK SYSTEMS, 67544011670 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PREPAK SYSTEMS, 67544011730 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544011753 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544011760 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544011770 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544011830 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544011853 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544011860 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544011870 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544011930 SERAX 30 MG CAPSULE 3771 OXAZEPAM PREPAK SYSTEMS, 67544011953 SERAX 30 MG CAPSULE 3771 OXAZEPAM PREPAK SYSTEMS, 67544011970 SERAX 30 MG CAPSULE 3771 OXAZEPAM PREPAK SYSTEMS, 67544012415 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544012430 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544012445 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544012453 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544012460 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544012470 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544012530 SERAX 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544012553 SERAX 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544012560 SERAX 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544012570 SERAX 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544013520 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544013530 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544013553 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544013560 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544013570 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544014215 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544014230 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 367 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544014245 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544014253 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544014260 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544014270 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544014430 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544014453 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544014460 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544014470 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544014480 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544014492 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544015330 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PREPAK SYSTEMS, 67544015530 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544015553 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544015560 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544015730 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544015753 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544015760 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544015765 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544015815 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544015830 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544015860 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544016230 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PREPAK SYSTEMS, 67544016253 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PREPAK SYSTEMS, 67544016260 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PREPAK SYSTEMS, 67544016730 ZYPREXA 5 MG TABLET 27961 OLANZAPINE PREPAK SYSTEMS, 67544016915 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544016930 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544016945 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544016953 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544017030 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544017153 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PREPAK SYSTEMS, 67544017160 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PREPAK SYSTEMS, 67544017170 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PREPAK SYSTEMS, 67544017180 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PREPAK SYSTEMS, 67544017253 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PREPAK SYSTEMS, 67544017260 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PREPAK SYSTEMS, 67544017280 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PREPAK SYSTEMS, 67544018930 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PREPAK SYSTEMS, 67544018953 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 368 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544019030 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PREPAK SYSTEMS, 67544019060 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL PREPAK SYSTEMS, 67544019115 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019130 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019145 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019153 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019160 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019170 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019180 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019190 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544019615 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019630 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019645 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019653 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019660 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019682 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019688 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019699 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544019830 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE PREPAK SYSTEMS, 67544020530 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544020553 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544020630 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544020660 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544020915 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544020930 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544020945 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544020953 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544020960 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544020973 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544021015 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PREPAK SYSTEMS, 67544021030 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PREPAK SYSTEMS, 67544021045 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PREPAK SYSTEMS, 67544021060 RISPERDAL 1 MG TABLET 21154 RISPERIDONE PREPAK SYSTEMS, 67544021130 RISPERDAL 2 MG TABLET 21155 RISPERIDONE PREPAK SYSTEMS, 67544021160 RISPERDAL 2 MG TABLET 21155 RISPERIDONE PREPAK SYSTEMS, 67544021330 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PREPAK SYSTEMS, 67544021353 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PREPAK SYSTEMS, 67544021360 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL PREPAK SYSTEMS, 67544021415 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 369 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544021430 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS, 67544021453 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS, 67544023515 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PREPAK SYSTEMS, 67544023530 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PREPAK SYSTEMS, 67544023545 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PREPAK SYSTEMS, 67544025330 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544025360 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544025370 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544026110 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026115 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026120 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026130 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026140 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026145 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026153 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026155 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026160 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026170 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026175 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026180 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026192 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544026830 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544026853 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544026860 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544026870 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544027430 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544027453 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544027460 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544027470 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544028053 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM PREPAK SYSTEMS, 67544028060 DEPAKOTE DR 500 MG TABLET 4540 DIVALPROEX SODIUM PREPAK SYSTEMS, 67544028130 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544028153 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544028182 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544028199 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE PREPAK SYSTEMS, 67544029015 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029030 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029045 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029053 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 370 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544029055 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029060 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029070 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029075 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029090 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544029453 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544029460 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544029470 OXAZEPAM 15 MG CAPSULE 3770 OXAZEPAM PREPAK SYSTEMS, 67544029530 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544029553 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544029560 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544029570 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544029580 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544029592 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544029815 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PREPAK SYSTEMS, 67544029830 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PREPAK SYSTEMS, 67544029845 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL PREPAK SYSTEMS, 67544029930 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544029953 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544031615 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544031620 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544031630 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544031645 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544031653 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544031660 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544031670 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544031715 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS, 67544031730 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS, 67544031753 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS, 67544031760 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS, 67544033130 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PREPAK SYSTEMS, 67544033153 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PREPAK SYSTEMS, 67544033160 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL PREPAK SYSTEMS, 67544034015 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034020 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034030 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034040 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034045 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034053 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 371 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544034055 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034060 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034070 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034075 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034080 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034090 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544034130 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544034153 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544034160 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544034170 OXAZEPAM 10 MG CAPSULE 3769 OXAZEPAM PREPAK SYSTEMS, 67544034715 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034730 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034745 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034753 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034755 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034760 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034770 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034775 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034780 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034790 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544034853 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544034860 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544034880 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544034890 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544034894 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544035215 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544035230 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544035245 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544035253 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544035260 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544035273 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544035715 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544035730 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544035745 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544035753 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544035815 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544035830 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544035860 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544036015 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 372 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544036030 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036045 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036053 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036060 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036073 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036515 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PREPAK SYSTEMS, 67544036530 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PREPAK SYSTEMS, 67544036553 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PREPAK SYSTEMS, 67544036560 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL PREPAK SYSTEMS, 67544036615 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036630 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036645 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036653 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036660 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036673 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544036815 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036820 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036830 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036840 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036845 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036853 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036855 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036860 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036870 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036875 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036880 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544036890 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544037230 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544037253 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544037260 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544037270 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544037275 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544037280 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL PREPAK SYSTEMS, 67544039110 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544039530 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544039545 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544039553 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544039560 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544039570 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 373 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544040630 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544040653 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544040670 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544040682 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544040699 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544040915 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544040930 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544040945 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544040953 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544040960 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544040973 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544041415 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544041430 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544041445 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544041453 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544041460 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544041470 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544041515 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041520 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041530 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041545 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041553 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041560 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041570 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041575 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041580 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041915 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041920 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041930 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041945 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041953 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041960 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041970 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041975 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544041980 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544042015 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042030 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042045 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042053 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 374 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544042055 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042060 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042070 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042075 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042080 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042090 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM PREPAK SYSTEMS, 67544042915 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544042930 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544042960 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE PREPAK SYSTEMS, 67544043015 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544043030 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544043045 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544043053 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE PREPAK SYSTEMS, 67544043315 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043320 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043330 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043340 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043345 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043353 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043355 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043360 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043370 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043375 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043380 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043390 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM PREPAK SYSTEMS, 67544043415 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PREPAK SYSTEMS, 67544043430 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PREPAK SYSTEMS, 67544043445 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL PREPAK SYSTEMS, 67544045515 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL PREPAK SYSTEMS, 67544046482 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL PREPAK SYSTEMS, 67544047953 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544047960 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544047970 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544047980 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544047990 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544047994 VALPROIC ACID 250 MG CAPSULE 4536 VALPROIC ACID PREPAK SYSTEMS, 67544048715 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544048730 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544048753 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 375 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544048775 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544049630 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PREPAK SYSTEMS, 67544049653 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PREPAK SYSTEMS, 67544049660 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM PREPAK SYSTEMS, 67544049982 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL PREPAK SYSTEMS, 67544049989 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL PREPAK SYSTEMS, 67544052830 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544052853 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544052860 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544052870 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544052880 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544054730 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544054753 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544054769 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544054782 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544054791 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL PREPAK SYSTEMS, 67544057230 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544057253 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544057260 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544057270 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL PREPAK SYSTEMS, 67544057830 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544057853 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544057860 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544057930 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544057953 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544057960 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544058030 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544058053 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544058060 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544058530 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544058553 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544058560 CHLORDIAZEPOXIDE 25 MG CAPSULE 3735 CHLORDIAZEPOXIDE HCL PREPAK SYSTEMS, 67544058815 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544058830 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544058845 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544058853 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544058860 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544058873 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544060010 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 376 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544060053 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544060070 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544060080 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544062915 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544062930 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544062953 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544062960 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544062970 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544062990 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM PREPAK SYSTEMS, 67544064015 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544064045 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544064060 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544064070 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544064075 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544067353 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544067370 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544067382 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544067399 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544070715 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544070730 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544070745 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544070753 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544070760 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544070770 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544070780 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544072060 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544072070 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM PREPAK SYSTEMS, 67544073415 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544073430 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544073445 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544073453 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544073460 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544073470 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544073480 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM PREPAK SYSTEMS, 67544075330 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM PREPAK SYSTEMS, 67544075360 OXAZEPAM 30 MG CAPSULE 3771 OXAZEPAM PREPAK SYSTEMS, 67544075830 ZYPREXA 20 MG TABLET 41027 OLANZAPINE PREPAK SYSTEMS, 67544081353 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM PREPAK SYSTEMS, 67544081760 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 377 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544084830 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544084845 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544084853 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544084860 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544084870 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544084880 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544084892 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL PREPAK SYSTEMS, 67544086360 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL PREPAK SYSTEMS, 67544087015 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087030 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087045 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087053 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087060 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087070 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087075 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087080 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM PREPAK SYSTEMS, 67544087915 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544087930 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544087945 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544087953 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544087960 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544087970 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544087975 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544087980 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544089253 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544089270 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544089280 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544089294 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL PREPAK SYSTEMS, 67544089753 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PREPAK SYSTEMS, 67544089760 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL PREPAK SYSTEMS, 67544090495 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM PREPAK SYSTEMS, 67544090615 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544090630 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544090645 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544090653 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544090660 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544090673 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544090815 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544090830 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS,

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 378 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67544090839 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544090845 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544090873 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544090880 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544093112 FLUPHENAZINE 5 MG TABLET 3826 FLUPHENAZINE HCL PREPAK SYSTEMS, 67544095915 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544095930 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544095945 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544095953 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544095960 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544095973 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544095980 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL PREPAK SYSTEMS, 67544098230 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544098253 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544098260 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM PREPAK SYSTEMS, 67544110243 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PREPAK SYSTEMS, 67544110293 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL PREPAK SYSTEMS, 67544112660 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL PREPAK SYSTEMS, 67544114039 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE PREPAK SYSTEMS, 67544114460 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL PREPAK SYSTEMS, 67544116960 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL PREPAK SYSTEMS, 67544128530 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544128553 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544128560 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544128570 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544128580 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM PREPAK SYSTEMS, 67544134680 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM PREPAK SYSTEMS, 67767013305 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767013325 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767013360 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767013560 BUPROPION HCL SR 200 MG TAB 50496 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767014130 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767014190 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767014205 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767014230 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767014290 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67767017160 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL ACTAVIS SOUTH ATLANTIC 67801031030 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE DIRECT PHARMACE 67801031203 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL DIRECT PHARMACE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 379 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 67801032103 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL DIRECT PHARMACE 67801040930 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE DIRECT PHARMACE 67801041103 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL DIRECT PHARMACE 67801043330 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL DIRECT PHARMACE 68030359202 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68030463401 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68030630401 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 68030630500 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 68030630501 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 68030931701 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 68030931702 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 68030931801 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 68030931802 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 68071004060 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 68071012230 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 68071012260 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 68071022230 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68071023130 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68071023152 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68071023160 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68071023190 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68071032230 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68071032240 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68071032260 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68071032290 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68071032330 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 68071032360 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 68071032390 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 68071033330 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 68071041215 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68071041230 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68071041260 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68071044415 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 68071044460 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 68071044515 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 68071044560 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 68071054860 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 68071070260 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 68071073460 CHLORDIAZEPOXIDE 10 MG CAPSULE 3734 CHLORDIAZEPOXIDE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 380 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68071077530 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM LABELER NOT ON FILE 68071131200 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 68071131300 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 68071131700 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 68071131800 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 68084001801 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084001811 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084001880 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084001885 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084001901 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084001911 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084001980 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084001985 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084002001 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084002011 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084002080 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084002081 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084002085 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM AMERICAN HEALTH PACKAGING 68084002801 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL AMERICAN HEALTH PACKAGING 68084002811 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL AMERICAN HEALTH PACKAGING 68084002901 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL AMERICAN HEALTH PACKAGING 68084002911 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL AMERICAN HEALTH PACKAGING 68084003001 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL AMERICAN HEALTH PACKAGING 68084003011 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL AMERICAN HEALTH PACKAGING 68084003101 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL AMERICAN HEALTH PACKAGING 68084003111 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL AMERICAN HEALTH PACKAGING 68084003201 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL AMERICAN HEALTH PACKAGING 68084003211 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL AMERICAN HEALTH PACKAGING 68084004201 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE AMERICAN HEALTH PACKAGING 68084004301 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE AMERICAN HEALTH PACKAGING 68084004311 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE AMERICAN HEALTH PACKAGING 68084004401 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004405 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004411 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004430 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004480 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004485 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004490 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004500 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 381 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68084004501 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004505 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004511 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004530 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004580 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004585 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004590 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004601 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004605 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004611 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004630 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004680 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004685 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004690 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004701 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004705 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004711 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004730 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004780 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004785 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084004790 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL AMERICAN HEALTH PACKAGING 68084008801 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM AMERICAN HEALTH PACKAGING 68084008811 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM AMERICAN HEALTH PACKAGING 68084008901 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM AMERICAN HEALTH PACKAGING 68084008911 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM AMERICAN HEALTH PACKAGING 68084009001 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM AMERICAN HEALTH PACKAGING 68084009011 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM AMERICAN HEALTH PACKAGING 68084011901 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084011906 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084011911 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084011930 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084012001 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084012006 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084012011 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084012030 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084012101 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084012111 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084012130 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE AMERICAN HEALTH PACKAGING 68084018001 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL AMERICAN HEALTH PACKAGING

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 382 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68084018011 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL AMERICAN HEALTH PACKAGING 68084018101 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL AMERICAN HEALTH PACKAGING 68084018111 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL AMERICAN HEALTH PACKAGING 68084018201 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL AMERICAN HEALTH PACKAGING 68084018211 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL AMERICAN HEALTH PACKAGING 68084023301 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE AMERICAN HEALTH PACKAGING 68084023311 CLOZAPINE 25 MG TABLET 13648 CLOZAPINE AMERICAN HEALTH PACKAGING 68084023401 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE AMERICAN HEALTH PACKAGING 68084023411 CLOZAPINE 100 MG TABLET 13649 CLOZAPINE AMERICAN HEALTH PACKAGING 68084024901 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL AMERICAN HEALTH PACKAGING 68084024911 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL AMERICAN HEALTH PACKAGING 68084025011 HALOPERIDOL 20 MG TABLET 3976 HALOPERIDOL AMERICAN HEALTH PACKAGING 68084025021 HALOPERIDOL 20 MG TABLET 3976 HALOPERIDOL AMERICAN HEALTH PACKAGING 68084025101 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084025111 BUPROPION HCL XL 150 MG TABLET 53006 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084025211 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084025221 BUPROPION HCL XL 300 MG TABLET 53007 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084027001 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027011 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027101 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027111 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027201 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027211 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027301 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027311 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027401 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027411 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027701 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE AMERICAN HEALTH PACKAGING 68084027711 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE AMERICAN HEALTH PACKAGING 68084031301 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031311 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031401 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031411 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031501 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031511 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031601 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031611 DIVALPROEX SOD ER 250 MG TAB 51469 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031701 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING 68084031711 DIVALPROEX SOD ER 500 MG TAB 46315 DIVALPROEX SODIUM AMERICAN HEALTH PACKAGING

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 383 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68084031801 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084031811 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084031901 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084031911 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084032011 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084032021 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084032111 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084032121 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084033001 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084033011 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084033101 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084033111 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084033411 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084033421 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084033511 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084033521 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE AMERICAN HEALTH PACKAGING 68084035901 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM AMERICAN HEALTH PACKAGING 68084035911 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM AMERICAN HEALTH PACKAGING 68084042001 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 68084042011 CHLORPROMAZINE 10 MG TABLET 3796 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 68084042101 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 68084042111 CHLORPROMAZINE 50 MG TABLET 3800 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 68084042201 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 68084042211 CHLORPROMAZINE 200 MG TABLET 3798 CHLORPROMAZINE HCL AMERICAN HEALTH PACKAGING 68084047001 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084047011 BUPROPION HCL SR 100 MG TABLET 46239 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084047101 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084047111 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL AMERICAN HEALTH PACKAGING 68084048401 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084048411 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084048501 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084048511 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084048601 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084048611 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL AMERICAN HEALTH PACKAGING 68084053001 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053011 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053101 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053111 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053201 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 384 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68084053211 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053301 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053311 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053401 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053411 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053501 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084053511 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE AMERICAN HEALTH PACKAGING 68084054801 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE AMERICAN HEALTH PACKAGING 68084054811 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE AMERICAN HEALTH PACKAGING 68084058109 ZIPRASIDONE HCL 20 MG CAPSULE 47563 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68084058111 ZIPRASIDONE HCL 20 MG CAPSULE 47563 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68084058209 ZIPRASIDONE HCL 40 MG CAPSULE 47564 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68084058211 ZIPRASIDONE HCL 40 MG CAPSULE 47564 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68084058309 ZIPRASIDONE HCL 60 MG CAPSULE 47567 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68084058311 ZIPRASIDONE HCL 60 MG CAPSULE 47567 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68084058409 ZIPRASIDONE HCL 80 MG CAPSULE 47568 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68084058411 ZIPRASIDONE HCL 80 MG CAPSULE 47568 ZIPRASIDONE HCL AMERICAN HEALTH PACKAGING 68094019358 VALPROIC ACID 250 MG/5 ML SOLN 68237 VALPROATE SODIUM PRECISION DOSE, INC. 68094019359 VALPROIC ACID 250 MG/5 ML SOLN 68220 VALPROATE SODIUM PRECISION DOSE, INC. 68094019361 VALPROIC ACID 250 MG/5 ML SOLN 68220 VALPROATE SODIUM PRECISION DOSE, INC. 68094019362 VALPROIC ACID 250 MG/5 ML SOLN 68220 VALPROATE SODIUM PRECISION DOSE, INC. 68094070161 VALPROIC ACID 500 MG/10 ML SOL 68236 VALPROATE SODIUM PRECISION DOSE, INC. 68094070162 VALPROIC ACID 500 MG/10 ML SOL 68236 VALPROATE SODIUM PRECISION DOSE, INC. 68094075059 DIAZEPAM 5 MG/5 ML ORAL SOLN 68715 DIAZEPAM PRECISION DOSE, INC. 68094075062 DIAZEPAM 5 MG/5 ML ORAL SOLN 68715 DIAZEPAM PRECISION DOSE, INC. 68094076759 LITHIUM CITRATE 8 MEQ/5 ML SOL 4006 LITHIUM CITRATE PRECISION DOSE, INC. 68094076762 LITHIUM CITRATE 8 MEQ/5 ML SOL 4006 LITHIUM CITRATE PRECISION DOSE, INC. 68115001400 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68115001406 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68115001420 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68115001430 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68115001460 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68115001490 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68115001500 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68115001506 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68115001510 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68115001520 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68115001530 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68115001540 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 385 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115001560 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68115001590 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68115001600 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68115001615 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68115001621 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68115001628 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68115001630 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68115001660 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68115001690 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68115001700 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 68115001721 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 68115001728 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 68115001730 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 68115001760 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 68115001796 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 68115001799 ALPRAZOLAM 2 MG TABLET 15566 ALPRAZOLAM LABELER NOT ON FILE 68115002100 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002130 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002200 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002230 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002260 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002290 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002300 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002330 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002360 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002390 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002399 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002400 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002430 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115002460 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115005200 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 68115005230 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 68115005260 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 68115005290 BUSPIRONE HCL 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 68115005300 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 68115005320 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 68115005390 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 68115007100 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68115007130 CELEXA 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 386 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115009800 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009801 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009802 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009810 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009830 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009860 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009890 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009896 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68115009915 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 68115009930 DIAZEPAM 2 MG TABLET 3767 DIAZEPAM LABELER NOT ON FILE 68115010001 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010002 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010006 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010010 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010015 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010020 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010030 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010060 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115010090 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68115012400 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 68115012430 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 68115012460 DOXEPIN 25 MG CAPSULE 46089 DOXEPIN HCL LABELER NOT ON FILE 68115014330 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 68115014360 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 68115014400 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68115014430 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68115014460 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68115014490 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68115014530 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 68115014560 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 68115014590 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 68115021100 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 68115021102 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 68115021106 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 68115021114 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 68115021130 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 68115021140 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 68115021160 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE 68115021190 LORAZEPAM 0.5 MG TABLET 3757 LORAZEPAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 387 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115021200 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 68115021215 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 68115021220 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 68115021230 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 68115021260 LORAZEPAM 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 68115026100 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026130 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026160 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026198 NORTRIPTYLINE HCL 10 MG CAP 46059 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026200 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026230 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026260 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026290 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115026730 PAXIL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 68115028015 SEROQUEL 300 MG TABLET 47198 QUETIAPINE FUMARATE LABELER NOT ON FILE 68115029330 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 68115029600 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68115029615 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68115029630 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68115029660 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68115029690 EFFEXOR XR 75 MG CAPSULE 46404 VENLAFAXINE HCL LABELER NOT ON FILE 68115029730 PAXIL CR 25 MG TABLET 50136 PAROXETINE HCL LABELER NOT ON FILE 68115033130 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 68115033160 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 68115033190 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 68115033230 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 68115033260 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 68115033290 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 68115033330 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 68115033360 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 68115033390 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 68115036500 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 68115036515 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 68115036530 ZOLOFT 100 MG TABLET 46229 SERTRALINE HCL LABELER NOT ON FILE 68115036600 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 68115036615 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 68115036630 ZOLOFT 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 68115037000 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 68115037030 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 388 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115037060 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE LABELER NOT ON FILE 68115037115 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 68115037130 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 68115037230 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 68115037260 EFFEXOR 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 68115037300 DEPAKOTE 500 MG TABLET EC 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 68115037315 DEPAKOTE 500 MG TABLET EC 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 68115037330 DEPAKOTE 500 MG TABLET EC 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 68115037360 DEPAKOTE 500 MG TABLET EC 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 68115037390 DEPAKOTE 500 MG TABLET EC 4540 DIVALPROEX SODIUM LABELER NOT ON FILE 68115037615 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 68115037630 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 68115038430 EFFEXOR 50 MG TABLET 46400 VENLAFAXINE HCL LABELER NOT ON FILE 68115039100 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 68115039115 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 68115039130 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 68115039160 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL LABELER NOT ON FILE 68115039800 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 68115039830 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 68115039860 LORAZEPAM 2 MG TABLET 3759 LORAZEPAM LABELER NOT ON FILE 68115040230 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 68115040260 DOXEPIN 50 MG CAPSULE 46090 DOXEPIN HCL LABELER NOT ON FILE 68115041230 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 68115041260 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 68115041290 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 68115041800 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115041830 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115041860 NORTRIPTYLINE HCL 50 MG CAP 46061 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115043030 AMITRIPTYLINE HCL 150 MG TAB 46045 AMITRIPTYLINE HCL LABELER NOT ON FILE 68115044560 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 68115044730 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 68115044760 BUPROPION SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 68115046700 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM LABELER NOT ON FILE 68115046730 DEPAKOTE ER 250 MG TABLET 51469 DIVALPROEX SODIUM LABELER NOT ON FILE 68115047730 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 68115047760 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 68115047790 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 68115047800 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68115047815 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 389 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115047830 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68115047860 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68115047890 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68115048230 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 68115048260 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 68115048360 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 68115048930 CITALOPRAM HBR 20 MG TABLET 46203 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68115049330 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68115049360 CITALOPRAM HBR 10 MG TABLET 46206 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68115050500 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 68115050515 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 68115050530 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 68115050560 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 68115050590 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 68115050615 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 68115050630 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 68115050830 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 68115050860 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 68115053200 BUSPAR 10 MG TABLET 3781 BUSPIRONE HCL LABELER NOT ON FILE 68115054430 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL LABELER NOT ON FILE 68115058600 TRIFLUOPERAZINE 5 MG TABLET 3854 TRIFLUOPERAZINE HCL LABELER NOT ON FILE 68115059100 DESIPRAMINE 25 MG TABLET 46106 DESIPRAMINE HCL LABELER NOT ON FILE 68115062400 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LABELER NOT ON FILE 68115064160 NEFAZODONE HCL 150 MG TABLET 46255 NEFAZODONE HCL LABELER NOT ON FILE 68115064500 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE LABELER NOT ON FILE 68115064530 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE LABELER NOT ON FILE 68115065630 PAXIL CR 12.5 MG TABLET 50137 PAROXETINE HCL LABELER NOT ON FILE 68115067060 GEODON 80 MG CAPSULE 47568 ZIPRASIDONE HCL LABELER NOT ON FILE 68115067600 BUPROPION HCL SR 100 MG TAB 46239 BUPROPION HCL LABELER NOT ON FILE 68115067660 BUPROPION HCL SR 100 MG TAB 46239 BUPROPION HCL LABELER NOT ON FILE 68115067900 DOXEPIN 100 MG CAPSULE 46087 DOXEPIN HCL LABELER NOT ON FILE 68115068900 DOXEPIN 150 MG CAPSULE 46088 DOXEPIN HCL LABELER NOT ON FILE 68115069415 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE LABELER NOT ON FILE 68115069460 RISPERDAL 0.25 MG TABLET 42922 RISPERIDONE LABELER NOT ON FILE 68115069530 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 68115069560 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 68115069590 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 68115069760 NEFAZODONE HCL 50 MG TABLET 46253 NEFAZODONE HCL LABELER NOT ON FILE 68115070100 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 390 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115070130 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 68115070190 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE LABELER NOT ON FILE 68115070815 ZYPREXA 10 MG TABLET 27960 OLANZAPINE LABELER NOT ON FILE 68115070830 ZYPREXA 10 MG TABLET 27960 OLANZAPINE LABELER NOT ON FILE 68115070860 ZYPREXA 10 MG TABLET 27960 OLANZAPINE LABELER NOT ON FILE 68115071000 MOBAN 25 MG TABLET 3989 MOLINDONE HCL LABELER NOT ON FILE 68115071330 ABILIFY 10 MG TABLET 51333 ARIPIPRAZOLE LABELER NOT ON FILE 68115071600 EFFEXOR 25 MG TABLET 46398 VENLAFAXINE HCL LABELER NOT ON FILE 68115071900 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68115071930 PROZAC 20 MG PULVULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68115073230 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE LABELER NOT ON FILE 68115073560 BUSPIRONE HCL 30 MG TABLET 44210 BUSPIRONE HCL LABELER NOT ON FILE 68115073600 ATIVAN 1 MG TABLET 3758 LORAZEPAM LABELER NOT ON FILE 68115073800 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 68115073830 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL LABELER NOT ON FILE 68115074000 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 68115074030 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 68115075130 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL LABELER NOT ON FILE 68115075815 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE LABELER NOT ON FILE 68115075830 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE LABELER NOT ON FILE 68115075845 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE LABELER NOT ON FILE 68115075860 ZYPREXA 2.5 MG TABLET 29077 OLANZAPINE LABELER NOT ON FILE 68115076400 TOFRANIL-PM 75 MG CAPSULE 46078 IMIPRAMINE PAMOATE LABELER NOT ON FILE 68115076550 ZOLOFT 25 MG TABLET 46227 SERTRALINE HCL LABELER NOT ON FILE 68115076700 AMOXAPINE 100 MG TABLET 46081 AMOXAPINE LABELER NOT ON FILE 68115078315 RISPERDAL 3 MG TABLET 21156 RISPERIDONE LABELER NOT ON FILE 68115078360 RISPERDAL 3 MG TABLET 21156 RISPERIDONE LABELER NOT ON FILE 68115079430 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE LABELER NOT ON FILE 68115079460 ZYPREXA 7.5 MG TABLET 27959 OLANZAPINE LABELER NOT ON FILE 68115079700 CELEXA 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LABELER NOT ON FILE 68115079860 NEFAZODONE HCL 100 MG TABLET 46254 NEFAZODONE HCL LABELER NOT ON FILE 68115080130 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL LABELER NOT ON FILE 68115080330 ZYPREXA 15 MG TABLET 41026 OLANZAPINE LABELER NOT ON FILE 68115080360 ZYPREXA 15 MG TABLET 41026 OLANZAPINE LABELER NOT ON FILE 68115080415 ABILIFY 15 MG TABLET 51334 ARIPIPRAZOLE LABELER NOT ON FILE 68115080430 ABILIFY 15 MG TABLET 51334 ARIPIPRAZOLE LABELER NOT ON FILE 68115081015 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 68115081030 WELLBUTRIN XL 150 MG TABLET 53006 BUPROPION HCL LABELER NOT ON FILE 68115081815 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 391 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115081830 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL LABELER NOT ON FILE 68115081860 GEODON 20 MG CAPSULE 47563 ZIPRASIDONE HCL LABELER NOT ON FILE 68115082000 PROVIGIL 100 MG TABLET 25848 MODAFINIL LABELER NOT ON FILE 68115082515 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 68115082530 WELLBUTRIN XL 300 MG TABLET 53007 BUPROPION HCL LABELER NOT ON FILE 68115082760 RISPERDAL 0.5 MG TABLET 42923 RISPERIDONE LABELER NOT ON FILE 68115083100 FLUVOXAMINE MALEATE 100 MG TAB 46210 FLUVOXAMINE MALEATE LABELER NOT ON FILE 68115083200 BUSPIRONE HCL 15 MG TABLET 27378 BUSPIRONE HCL LABELER NOT ON FILE 68115083560 WELLBUTRIN SR 200 MG TABLET 50496 BUPROPION HCL LABELER NOT ON FILE 68115084200 SEROQUEL 25 MG TABLET 34187 QUETIAPINE FUMARATE LABELER NOT ON FILE 68115084400 CLOMIPRAMINE 25 MG CAPSULE 46120 CLOMIPRAMINE HCL LABELER NOT ON FILE 68115084730 REMERON 30 MG SOLTAB 47454 MIRTAZAPINE LABELER NOT ON FILE 68115084800 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 68115085260 LAMICTAL 200 MG TABLET 22551 LAMOTRIGINE LABELER NOT ON FILE 68115085615 RISPERDAL 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 68115085660 RISPERDAL 2 MG TABLET 21155 RISPERIDONE LABELER NOT ON FILE 68115085700 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL LABELER NOT ON FILE 68115085900 DOXEPIN 10 MG CAPSULE 46086 DOXEPIN HCL LABELER NOT ON FILE 68115086600 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE 68115087000 NORTRIPTYLINE HCL 75 MG CAP 46062 NORTRIPTYLINE HCL LABELER NOT ON FILE 68115087300 PROVIGIL 200 MG TABLET 41478 MODAFINIL LABELER NOT ON FILE 68115087800 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68115088400 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 68115088600 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 68115088615 SEROQUEL 100 MG TABLET 34188 QUETIAPINE FUMARATE LABELER NOT ON FILE 68115090160 WELLBUTRIN SR 150 MG TABLET 46238 BUPROPION HCL LABELER NOT ON FILE 68115091200 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 68115091215 SEROQUEL 200 MG TABLET 34189 QUETIAPINE FUMARATE LABELER NOT ON FILE 68115091330 PAXIL CR 37.5 MG TABLET 50138 PAROXETINE HCL LABELER NOT ON FILE 68115092030 REMERON 15 MG SOLTAB 47453 MIRTAZAPINE LABELER NOT ON FILE 68115092130 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 68115092160 ZYPREXA 5 MG TABLET 27961 OLANZAPINE LABELER NOT ON FILE 68115092660 WELLBUTRIN SR 100 MG TABLET 46239 BUPROPION HCL LABELER NOT ON FILE 68115092860 RISPERDAL 1 MG TABLET 21154 RISPERIDONE LABELER NOT ON FILE 68115092960 NEFAZODONE HCL 200 MG TABLET 46256 NEFAZODONE HCL LABELER NOT ON FILE 68115093015 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL LABELER NOT ON FILE 68115093030 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL LABELER NOT ON FILE 68115093045 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL LABELER NOT ON FILE 68115093060 GEODON 40 MG CAPSULE 47564 ZIPRASIDONE HCL LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 392 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68115097400 EFFEXOR XR 37.5 MG CAPSULE 46403 VENLAFAXINE HCL LABELER NOT ON FILE 68180026501 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM LUPIN PHARMACEUTICALS, INC. 68180026601 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM LUPIN PHARMACEUTICALS, INC. 68180026602 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM LUPIN PHARMACEUTICALS, INC. 68180026701 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM LUPIN PHARMACEUTICALS, INC. 68180026702 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM LUPIN PHARMACEUTICALS, INC. 68180031101 IMIPRAMINE HCL 10 MG TABLET 46068 IMIPRAMINE HCL LUPIN PHARMACEUTICALS, INC. 68180031201 IMIPRAMINE HCL 25 MG TABLET 46069 IMIPRAMINE HCL LUPIN PHARMACEUTICALS, INC. 68180031301 IMIPRAMINE HCL 50 MG TABLET 46070 IMIPRAMINE HCL LUPIN PHARMACEUTICALS, INC. 68180031406 IMIPRAMINE PAMOATE 75 MG CAP 46078 IMIPRAMINE PAMOATE LUPIN PHARMACEUTICALS, INC. 68180031506 IMIPRAMINE PAMOATE 100 MG CAP 46075 IMIPRAMINE PAMOATE LUPIN PHARMACEUTICALS, INC. 68180031606 IMIPRAMINE PAMOATE 125 MG CAP 46076 IMIPRAMINE PAMOATE LUPIN PHARMACEUTICALS, INC. 68180031706 IMIPRAMINE PAMOATE 150 MG CAP 46077 IMIPRAMINE PAMOATE LUPIN PHARMACEUTICALS, INC. 68180033107 ZIPRASIDONE HCL 20 MG CAPSULE 47563 ZIPRASIDONE HCL LUPIN PHARMACEUTICALS, INC. 68180033207 ZIPRASIDONE HCL 40 MG CAPSULE 47564 ZIPRASIDONE HCL LUPIN PHARMACEUTICALS, INC. 68180033307 ZIPRASIDONE HCL 60 MG CAPSULE 47567 ZIPRASIDONE HCL LUPIN PHARMACEUTICALS, INC. 68180033407 ZIPRASIDONE HCL 80 MG CAPSULE 47568 ZIPRASIDONE HCL LUPIN PHARMACEUTICALS, INC. 68180035106 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035109 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035201 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035202 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035205 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035206 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035209 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035301 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035302 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035305 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035306 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180035309 SERTRALINE HCL 100 MG TABLET 46229 SERTRALINE HCL LUPIN PHARMACEUTICALS, INC. 68180044501 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044503 QUETIAPINE FUMARATE 25 MG TAB 34187 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044601 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044603 QUETIAPINE FUMARATE 50 MG TAB 60292 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044701 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044703 QUETIAPINE FUMARATE 100 MG TAB 34188 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044801 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044802 QUETIAPINE FUMARATE 200 MG TAB 34189 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044901 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180044902 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 393 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68180044907 QUETIAPINE FUMARATE 300 MG TAB 47198 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180045001 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68180045002 QUETIAPINE FUMARATE 400 MG TAB 60293 QUETIAPINE FUMARATE LUPIN PHARMACEUTICALS, INC. 68258101001 FLUOXETINE HCL 20 MG TABLET 46219 FLUOXETINE HCL DISPENSING SOLN 68258103101 DEPAKOTE ER 500 MG TABLET 46315 DIVALPROEX SODIUM DISPENSING SOLN 68258106101 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL DISPENSING SOLN 68258700303 FLUOXETINE HCL 40 MG CAPSULE 46215 FLUOXETINE HCL DISPENSING SOLN 68258700403 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE DISPENSING SOLN 68258700503 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE DISPENSING SOLN 68258700603 MIRTAZAPINE 45 MG TABLET 46452 MIRTAZAPINE DISPENSING SOLN 68258700703 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL DISPENSING SOLN 68258700803 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL DISPENSING SOLN 68258701003 SERTRALINE HCL 25 MG TABLET 46227 SERTRALINE HCL DISPENSING SOLN 68258701203 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM DISPENSING SOLN 68258704303 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL DISPENSING SOLN 68258704403 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL DISPENSING SOLN 68258710903 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL DISPENSING SOLN 68258904901 ABILIFY 30 MG TABLET 51336 ARIPIPRAZOLE DISPENSING SOLN 68258908101 LAMICTAL 200 MG TABLET 22551 LAMOTRIGINE DISPENSING SOLN 68258911201 LAMICTAL 100 MG TABLET 17871 LAMOTRIGINE DISPENSING SOLN 68258911701 EFFEXOR 37.5 MG TABLET 46399 VENLAFAXINE HCL DISPENSING SOLN 68258912701 LAMICTAL 25 MG TABLET 17872 LAMOTRIGINE DISPENSING SOLN 68258914501 LAMICTAL 150 MG TABLET 22550 LAMOTRIGINE DISPENSING SOLN 68322000101 FAZACLO 25 MG TABLET 53994 CLOZAPINE AVANIR PHARMACEUTICALS 68322000102 FAZACLO 25 MG TABLET 53994 CLOZAPINE AVANIR PHARMACEUTICALS 68322000103 FAZACLO 25 MG TABLET 53994 CLOZAPINE AVANIR PHARMACEUTICALS 68322000104 FAZACLO 25 MG TABLET 53994 CLOZAPINE AVANIR PHARMACEUTICALS 68322000201 FAZACLO 100 MG TABLET 53995 CLOZAPINE AVANIR PHARMACEUTICALS 68322000202 FAZACLO 100 MG TABLET 53995 CLOZAPINE AVANIR PHARMACEUTICALS 68322000203 FAZACLO 100 MG TABLET 53995 CLOZAPINE AVANIR PHARMACEUTICALS 68322000204 FAZACLO 100 MG TABLET 53995 CLOZAPINE AVANIR PHARMACEUTICALS 68382000101 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382000105 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382000106 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382000110 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382000116 PAROXETINE HCL 40 MG TABLET 46225 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382000601 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382000605 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382000610 LAMOTRIGINE 25 MG TABLET 17872 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 394 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68382000801 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382000805 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382000810 LAMOTRIGINE 100 MG TABLET 17871 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382000905 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382000914 LAMOTRIGINE 150 MG TABLET 22550 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382001005 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382001014 LAMOTRIGINE 200 MG TABLET 22551 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382001801 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382001810 VENLAFAXINE HCL 25 MG TABLET 46398 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382001901 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382001910 VENLAFAXINE HCL 37.5 MG TABLET 46399 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382002001 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382002010 VENLAFAXINE HCL 50 MG TABLET 46400 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382002101 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382002110 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003101 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382003105 DIVALPROEX SOD DR 125 MG TAB 4538 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382003201 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382003205 DIVALPROEX SOD DR 250 MG TAB 4539 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382003301 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382003305 DIVALPROEX SOD DR 500 MG TAB 4540 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382003406 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003410 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003416 VENLAFAXINE HCL ER 37.5 MG CAP 46403 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003506 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003510 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003516 VENLAFAXINE HCL ER 75 MG CAP 46404 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003606 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003610 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382003616 VENLAFAXINE HCL ER 150 MG CAP 46405 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382008001 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL ZYDUS PHARMACEUTICALS (USA) INC. 68382008010 HALOPERIDOL 10 MG TABLET 3974 HALOPERIDOL ZYDUS PHARMACEUTICALS (USA) INC. 68382008101 HALOPERIDOL 20 MG TABLET 3976 HALOPERIDOL ZYDUS PHARMACEUTICALS (USA) INC. 68382009701 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009705 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009706 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009710 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009716 PAROXETINE HCL 10 MG TABLET 46222 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009801 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 395 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68382009805 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009806 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009810 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009816 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009901 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009905 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009906 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009910 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382009916 PAROXETINE HCL 30 MG TABLET 46224 PAROXETINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382010101 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382010110 VENLAFAXINE HCL 100 MG TABLET 46402 VENLAFAXINE HCL ZYDUS PHARMACEUTICALS (USA) INC. 68382010601 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382010610 DIVALPROEX SODIUM 125 MG CAP 4537 DIVALPROEX SODIUM ZYDUS PHARMACEUTICALS (USA) INC. 68382010801 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382010805 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382010901 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382010905 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE ZYDUS PHARMACEUTICALS (USA) INC. 68382011205 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011214 RISPERIDONE 0.25 MG TABLET 42922 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011305 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011314 RISPERIDONE 0.5 MG TABLET 42923 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011405 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011414 RISPERIDONE 1 MG TABLET 21154 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011505 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011514 RISPERIDONE 2 MG TABLET 21155 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011605 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011614 RISPERIDONE 3 MG TABLET 21156 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011705 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382011714 RISPERIDONE 4 MG TABLET 21157 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382015406 RISPERIDONE 0.5 MG ODT 52049 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382015506 RISPERIDONE 1 MG ODT 51799 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68382015606 RISPERIDONE 2 MG ODT 51800 RISPERIDONE ZYDUS PHARMACEUTICALS (USA) INC. 68387011230 PAROXETINE HCL 20 MG TABLET 46223 PAROXETINE HCL LABELER NOT ON FILE 68387011930 SERTRALINE HCL 50 MG TABLET 46228 SERTRALINE HCL LABELER NOT ON FILE 68387012030 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68387012060 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68387012090 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LABELER NOT ON FILE 68387012530 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LABELER NOT ON FILE 68387012730 LEXAPRO 10 MG TABLET 50712 ESCITALOPRAM OXALATE LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 396 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68387012830 LEXAPRO 20 MG TABLET 50760 ESCITALOPRAM OXALATE LABELER NOT ON FILE 68387016030 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LABELER NOT ON FILE 68387016530 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 68387016560 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 68387016590 TRAZODONE 50 MG TABLET 46241 TRAZODONE HCL LABELER NOT ON FILE 68387016630 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 68387016660 TRAZODONE 100 MG TABLET 46242 TRAZODONE HCL LABELER NOT ON FILE 68387033015 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 68387033030 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 68387033060 NORTRIPTYLINE HCL 25 MG CAP 46060 NORTRIPTYLINE HCL LABELER NOT ON FILE 68387033515 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033524 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033530 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033560 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033590 AMITRIPTYLINE HCL 25 MG TAB 46046 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033630 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033690 AMITRIPTYLINE HCL 10 MG TAB 46043 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033724 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033730 AMITRIPTYLINE HCL 50 MG TAB 46047 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033830 AMITRIPTYLINE HCL 75 MG TAB 46048 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387033930 AMITRIPTYLINE HCL 100 MG TAB 46044 AMITRIPTYLINE HCL LABELER NOT ON FILE 68387034830 VENLAFAXINE HCL 75 MG TABLET 46401 VENLAFAXINE HCL LABELER NOT ON FILE 68387034915 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68387034930 EFFEXOR XR 150 MG CAPSULE 46405 VENLAFAXINE HCL LABELER NOT ON FILE 68387035030 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 68387035060 BUPROPION HCL 75 MG TABLET 46236 BUPROPION HCL LABELER NOT ON FILE 68387035330 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 68387035360 BUPROPION HCL 100 MG TABLET 46237 BUPROPION HCL LABELER NOT ON FILE 68387035530 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 68387035560 BUSPIRONE HCL 5 MG TABLET 3782 BUSPIRONE HCL LABELER NOT ON FILE 68387036060 MIRTAZAPINE 15 MG TABLET 46450 MIRTAZAPINE LABELER NOT ON FILE 68387036307 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 68387036315 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 68387036330 MIRTAZAPINE 30 MG TABLET 46451 MIRTAZAPINE LABELER NOT ON FILE 68387046018 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68387046030 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68387046060 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68387046090 ALPRAZOLAM 0.5 MG TABLET 3774 ALPRAZOLAM LABELER NOT ON FILE 68387046530 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 397 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68387046545 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68387046560 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68387046590 ALPRAZOLAM 0.25 MG TABLET 3773 ALPRAZOLAM LABELER NOT ON FILE 68387046630 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68387046645 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68387046660 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68387046690 ALPRAZOLAM 1 MG TABLET 3775 ALPRAZOLAM LABELER NOT ON FILE 68387047430 DIAZEPAM 5 MG TABLET 3768 DIAZEPAM LABELER NOT ON FILE 68387047501 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68387047530 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68387047590 DIAZEPAM 10 MG TABLET 3766 DIAZEPAM LABELER NOT ON FILE 68387051090 CLORAZEPATE 3.75 MG TABLET 3745 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 68387051190 CLORAZEPATE 7.5 MG TABLET 3746 CLORAZEPATE DIPOTASSIUM LABELER NOT ON FILE 68387055330 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 68387055360 CYMBALTA 60 MG CAPSULE 57893 DULOXETINE HCL LABELER NOT ON FILE 68387055430 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 68387055460 CYMBALTA 30 MG CAPSULE 57892 DULOXETINE HCL LABELER NOT ON FILE 68405800306 TRAZAMINE CONVENIENCE PACK 60738 TRAZODONE HCL/DIET8 PHYSICIAN THERAPEUTICS LLC 68405800916 APPBUTAMONE-D CONVENIENCE PACK 62578 BUPROPION HCL/DIET SUPP. NO.15PHYSICIAN THERAPEUTICS LLC 68405801426 GABOXETINE CONVENIENCE PACK 62576 FLUOXETINE HCL/DIET.SUPP NO.17PHYSICIAN THERAPEUTICS LLC 68405802116 APPBUTAMONE CONVENIENCE PACK 62579 BUPROPION HCL/DIET SUPP. NO.16PHYSICIAN THERAPEUTICS LLC 68405802426 GABAZOLAMINE CONVENIENCE PACK 62647 ALPRAZOLAM/DIETARY SUPPL NO.17PHYSICIAN THERAPEUTICS LLC 68405804326 SENTROXATINE CONVENIENCE PACK 62574 FLUOXETINE HCL/DIET. SUPP NO.8PHYSICIAN THERAPEUTICS LLC 68462022001 LITHIUM CARBONATE 150 MG CAP 4000 LITHIUM CARBONATE GLENMARK PHARMACEUTICALS, INC., USA 68462022101 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE GLENMARK PHARMACEUTICALS, INC., USA 68462022110 LITHIUM CARBONATE 300 MG CAP 4001 LITHIUM CARBONATE GLENMARK PHARMACEUTICALS, INC., USA 68462022201 LITHIUM CARBONATE 600 MG CAP 4002 LITHIUM CARBONATE GLENMARK PHARMACEUTICALS, INC., USA 68462022301 LITHIUM CARBONATE ER 300 MG TB 4004 LITHIUM CARBONATE GLENMARK PHARMACEUTICALS, INC., USA 68462022401 LITHIUM ER 450 MG TABLET 4005 LITHIUM CARBONATE GLENMARK PHARMACEUTICALS, INC., USA 68462022801 LAMOTRIGINE 5 MG DISPER TABLET 21935 LAMOTRIGINE GLENMARK PHARMACEUTICALS, INC., USA 68462022901 LAMOTRIGINE 25 MG DISPER TAB 21934 LAMOTRIGINE GLENMARK PHARMACEUTICALS, INC., USA 68645013054 FLUOXETINE HCL 20 MG CAPSULE 46214 FLUOXETINE HCL LEGACY PHARMACEUTICAL PACKAGING, LLC 68645013154 FLUOXETINE HCL 10 MG CAPSULE 46213 FLUOXETINE HCL LEGACY PHARMACEUTICAL PACKAGING, LLC 68645018054 TRAZODONE 150 MG TABLET 46243 TRAZODONE HCL LEGACY PHARMACEUTICAL PACKAGING, LLC 68645025254 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LEGACY PHARMACEUTICAL PACKAGING, LLC 68645028254 CITALOPRAM HBR 40 MG TABLET 46204 CITALOPRAM HYDROBROMIDE LEGACY PHARMACEUTICAL PACKAGING, LLC 68727060001 LUVOX CR 100 MG CAPSULE 63767 FLUVOXAMINE MALEATE JAZZ PHARMACEUTICALS, INC. 68727060101 LUVOX CR 150 MG CAPSULE 63768 FLUVOXAMINE MALEATE JAZZ PHARMACEUTICALS, INC. 68968201001 PEXEVA 10 MG TABLET 53387 PAROXETINE MESYLATE NOVEN THERAPEUTICS, LLC.

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 398 of 399 Oregon Health Authority Division of Medical Assistance Programs Weekly 7/11 Drug Carveout List Generic Drug NDC Label Name Desc Sequence No. Generic Drug Name Labeler Name 68968202001 PEXEVA 20 MG TABLET 53388 PAROXETINE MESYLATE NOVEN THERAPEUTICS, LLC. 68968203001 PEXEVA 30 MG TABLET 53389 PAROXETINE MESYLATE NOVEN THERAPEUTICS, LLC. 68968204001 PEXEVA 40 MG TABLET 53390 PAROXETINE MESYLATE NOVEN THERAPEUTICS, LLC. 68968312501 STAVZOR DR 125 MG CAPSULE 64275 VALPROIC ACID NOVEN THERAPEUTICS, LLC. 68968325001 STAVZOR DR 250 MG CAPSULE 64276 VALPROIC ACID NOVEN THERAPEUTICS, LLC. 68968350001 STAVZOR DR 500 MG CAPSULE 13477 VALPROIC ACID NOVEN THERAPEUTICS, LLC. 68968449201 LITHOBID 300 MG TABLET SA 4004 LITHIUM CARBONATE NOVEN THERAPEUTICS, LLC. 73913127290 ST. JOHN'S WORT 225MG CAP 46332 ST. JOHN'S WORT BINDLY WESTERN 74312037841 ST. JOHN'S WORT SOLUTION 46339 ST. JOHN'S WORT NATURE'S BOUNTY, INC. 79854000682 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT NATIONAL VITAMIN COMPANY 79854001445 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT NATIONAL VITAMIN COMPANY 79854014405 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT NATIONAL VITAMIN COMPANY 79854021445 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT NATIONAL VITAMIN COMPANY 87701048153 GNP ST JOHN WORT 300 MG CPLT 46337 ST. JOHN'S WORT BRITE LIFE 87701060912 BL ST JOHN WORT 300 MG CPLT 46337 ST. JOHN'S WORT BRITE LIFE 87701089542 GNP ST. JOHN'S WORT 150 MG 46331 ST. JOHN'S WORT BRITE LIFE 87701089571 BL ST. JOHN'S WORT 150 MG 46331 ST. JOHN'S WORT BRITE LIFE 93190014003 MOVANA 300 MG TABLET 46337 ST. JOHN'S WORT LABELER NOT ON FILE 93190014004 MOVANA 300 MG TABLET 46337 ST. JOHN'S WORT LABELER NOT ON FILE 96121000258 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT LABELER NOT ON FILE 96295011760 ST. JOHN'S WORT 300 MG CAPSULE 46333 ST. JOHN'S WORT LABELER NOT ON FILE

Not all the drugs on this list are covered by DMAP as many are not rebateable or expired NDCs. 399 of 399