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Home , Diosgenin, Mequinol, Moxisylyte, Triclosan

Tier 1 Preventive Drugs The following Preferred Drug List is an abbreviated version of commonly Generics: $0: -Day 1 prescribed . This list is intended to be a guide and prescriber's should still use generics when possible.

A E GARDASIL 9 SUSY NICOTINE LOZENGE GAVILYTE-C NICOTINE POLACRILEX ADACEL ECOTRIN (ALL STRENGTHS/FORMS) GAVILYTE-H NICOTINE TRANSDERMAL SYSTEM AFLURIA PRESERVATIVE FREE ECPIRIN 325 MG TAB DR GAVILYTE-N/FLAVOR PACK NORETHINDRONE AFLURIA PRESERVATIVE FREE SUSY 0.5ML ENGERIX-B GIANVI NORETHINDRONE & ETHINYL FERROUS FUMARATE AFLURIA QUADRIVALENT ENGERIX-B INJ 10MCG/0.5ML GOODSENSE ASPIRIN (ALL STRENGTHS/FORMS) NORETHINDRONE ACETATE/ETHINYL ESTRADIOL AFLURIA QUADRIVALENT SUSY 0.25ML ENGERIX-B INJ 20MCG/ML GOODSENSE NICOTINE GUM NORETHINDRONE ACETATE/ETHINYL ESTRADIOL/FERROUS FUMARATE AFLURIA SUSP ENGERIX-B SUSP 10MCG/0.5ML GOODSENSE NICOTINE POLACRILEX NORETHINDRONE/ETHINYL ESTRADIOL/FERROUS FUMARATE AMETHYST ENGERIX-B SUSP 20MCG/ML NORTREL 0.5/35 (28) ARANELLE ENPRESSE-28 NORTREL 1/35 ASPIR-LOW 81 MG TAB DR EQ NICOTINE H HAVRIX NORTREL 7/7/7 ASPIRIN 325 MG TAB ERYTHROMYCIN HAVRIX SUSP 1440EL U/ML NORWICH ASPIRIN 325 MG TAB ASPIRIN 81 MG CHEW TAB ERYTHROMYCIN OIN 5MG/GM HAVRIX SUSP 720EL U/0.5ML ASPIRIN ADULT LOW DOSE 81 MG TAB DR ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL HEPLISAV-B ASPIRIN CHILDRENS 81 MG CHEW TAB EZ FLU SHOT-FLUCELVAX QUAD O HEPLISAV-B SOLN 20MCG/0.5ML OPTION 2 ASPIRIN EC 325 MG TAB DR EZ FLU SHOT-FLUCELVAX QUAD PSKT 0.5ML HEPLISAV-B SOSY 20MCG/0.5ML ORSYTHIA ASPIRIN EC 81 MG TAB DR

ASPIRIN EC LOW DOSE 81 MG TAB F ASPIRIN EC LOW STRENGTH 81 MG TAB DR FA-8 800 MCG TAB I P INFANRIX PEG 3350/ELECTROLYTES ASPIRIN LOW DOSE 81 MG CHEW TAB FER-IRON PEG-3350/ELECTROLYTES ASPIRTAB 324 MG TAB DR FLUAD PEG-3350/NACL/NA BICARBONATE/KCL ASPIRTAB MAXIMUM STRENGTH 500 MG TAB FLUAD SUSY 0.5ML J JUNEL FE 1.5/30 PEG-PREP ATORVASTATIN FLUBLOK QUADRIVALENT FLUBLOK QUADRIVALENT SOSY 0.5ML JUNEL FE 24 PFIZER-BIONTECH COVID-19 VACC B FLUCELVAX QUADRIVALENT PNEUMOVAX 23 PNEUMOVAX 23 INJ 25MCG/0.5ML BALZIVA FLUCELVAX QUADRIVALENT SUSP K KELNOR 1/50 PRAVASTATIN SODIUM BAYER ASPIRIN (ALL STRENGTHS/FORMS) FLUCELVAX QUADRIVALENT SUSY 0.5ML KP BISACODYL PREVIFEM BEXSERO FLULAVAL QUADRIVALENT PREVNAR 13 BEXSERO SUSY FLULAVAL QUADRIVALENT SUSP PREVNAR 13 SUSP BISACODYL FLULAVAL QUADRIVALENT SUSY 0.5ML L /ETHINYL ESTRADIOL PROQUAD BISACODYL EC FLUORABON DRO LOVASTATIN PROQUAD SUSR BOOSTRIX FLUORITAB CHW 0.25MG F HYDROCHLORIDE ER (SR) FLUORITAB CHW 0.5MG F BUPROPION TAB FLUORITAB CHW 1MG F M R FLUORITAB DRO 0.125MG M-M-R II RA MAGNESIA C FLURA-DROPS DRO 0.25MG F CITRATE RA NICOTINE TRANSDERMAL SYSTEM REFILL MEDIQUE ASPIRIN 325 MG TAB RA NICOTINE TRANSDERMAL SYSTEM STARTER KIT CAMRESE FLUVASTATIN MEDROXYPR AC INJ 150MG/ML HYDROCHLORIDE CAMRESE LO FLUVASTATIN SODIUM ER MENACTRA RECLIPSEN CHANTIX FLUZONE HIGH-DOSE MENACTRA INJ RECOMBIVAX HB CHANTIX CONTINUING MONTHPAK FLUZONE HIGH-DOSE SUSY 0.5ML MENVEO RECOMBIVAX HB SUSP 10MCG/ML CHANTIX STARTING MONTH PAK FLUZONE QUADRIVALENT MENVEO SOLR RECOMBIVAX HB SUSP 40MCG/ML CITRATE OF MAGNESIA FLUZONE QUADRIVALENT SUSP 0.5ML MILK OF MAGNESIA RECOMBIVAX HB SUSP 5MCG/0.5ML CRYSELLE-28 FOLATE 400 MCG TAB FOLIC ACID 1 MG TAB MILK OF MAGNESIA CONCENTRATE RIVELSA D FOLIC ACID 400 MCG TAB MINIPRIN LOW DOSE | 81 MG TAB DR ROSUVASTATIN CALCIUM MODERNA COVID-19 VACCINE DAPTACEL FOLIC ACID 800 MCG TAB /ETHINYL ESTRADIOL S SHINGRIX DIPHTHERIA-TETANUS TOXOIDS DT G N NICOTINE SHINGRIX SUSR 50MCG/0.5ML /ETHINYL ESTRADIOL GARDASIL 9 NICOTINE GUM SIMVASTATIN DROSPIRENONE/ETHINYL ESTRADIOL/LEVOMEFOLATE CALCIUM GARDASIL 9 SUSP

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. SOD FLUORIDE DRO 0.5MG/ML A ALENDRONATE SODIUM TABS 70MG HCL TABS 50MG SOD FLUORIDE TAB 0.5MG F ABACAVIR SULFATE-LAMIVUDINE TABS 600-300MG ALFENTANIL HCL SOLN 1000MCG/2ML AMITRIPTYLINE HCL TABS 75MG SOD FLUORIDE TAB 1MG F ACAMPROSATE CALCIUM TBEC 333MG ALFENTANIL HCL SOLN 2500MCG/5ML AMLODIPINE BESY-BENAZEPRIL HCL CAPS 10-20MG ST JOSEPH ASPIRIN (ALL STRENGTHS/FORMS) ACARBOSE TABS 100MG HCL ER TB24 10MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 10-40MG ACARBOSE TABS 25MG ALISKIREN FUMARATE TABS 150MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 2.5-10MG T HCL CAPS 200MG ALISKIREN FUMARATE TABS 300MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 5-10MG CITRATE ACEBUTOLOL HCL CAPS 400MG ALLOPURINOL SODIUM SOLR 500MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 5-20MG TENIVAC ACETAMINOPHEN-CODEINE #2 TABS 300-15MG ALLOPURINOL TABS 100MG AMLODIPINE BESY-BENAZEPRIL HCL CAPS 5-40MG TETANUS-DIPHTHERIA TOXOIDS TD ACETAMINOPHEN-CODEINE #3 TABS 300-30MG ALLOPURINOL TABS 300MG AMLODIPINE BESYLATE TABS 10MG THRIVE ACETAMINOPHEN-CODEINE #4 TABS 300-60MG ALMOTRIPTAN MALATE TABS 12.5MG AMLODIPINE BESYLATE TABS 2.5MG TRI-LEGEST FE ACETAMINOPHEN-CODEINE SOLN 120-12MG/5ML ALMOTRIPTAN MALATE TABS 6.25MG AMLODIPINE BESYLATE TABS 5MG TRI-LO-SPRINTEC ACETAZOLAMIDE ER CP12 500MG ALOSETRON HCL TABS 0.5MG AMLODIPINE BESYLATE-VALSARTAN TABS 10-160MG TRI-PREVIFEM ACETAZOLAMIDE SODIUM SOLR 500MG ALOSETRON HCL TABS 1MG AMLODIPINE BESYLATE-VALSARTAN TABS 10-320MG TRUMENBA ACETAZOLAMIDE TABS 125MG ALPRAZOLAM ER TB24 0.5MG AMLODIPINE BESYLATE-VALSARTAN TABS 5-160MG TRUMENBA SUSY ACETAZOLAMIDE TABS 250MG ALPRAZOLAM ER TB24 1MG AMLODIPINE BESYLATE-VALSARTAN TABS 5-320MG TWINRIX ACETIC ACID SOLN 0.25% ALPRAZOLAM ER TB24 2MG AMLODIPINE-ATORVASTATIN TABS 10-10MG TWINRIX SUSY 720-20ELU-MCG/ML ACETIC ACID SOLN 2% ALPRAZOLAM ER TB24 3MG AMLODIPINE-ATORVASTATIN TABS 10-20MG ACETYLCYSTEINE SOLN 10% ALPRAZOLAM TABS 0.25MG AMLODIPINE-ATORVASTATIN TABS 10-40MG V ACETYLCYSTEINE SOLN 20% ALPRAZOLAM TABS 0.5MG AMLODIPINE-ATORVASTATIN TABS 10-80MG VARIVAX ACETYLCYSTEINE SOLN 200MG/ML ALPRAZOLAM TABS 1MG AMLODIPINE-ATORVASTATIN TABS 2.5-10MG VARIVAX INJ 1350PFU/0.5ML ACYCLOVIR CAPS 200MG ALPRAZOLAM TABS 2MG AMLODIPINE-ATORVASTATIN TABS 2.5-20MG VELIVET ACYCLOVIR CREA 5% ALPRAZOLAM TBDP 0.25MG AMLODIPINE-ATORVASTATIN TABS 2.5-40MG Tier 2 ACYCLOVIR OINT 5% ALPRAZOLAM TBDP 0.5MG AMLODIPINE-ATORVASTATIN TABS 5-10MG Z Generics: ACYCLOVIR SODIUM SOLN 50MG/ML ALPRAZOLAM TBDP 1MG AMLODIPINE-ATORVASTATIN TABS 5-20MG ZOSTAVAX $15.00 - After ACYCLOVIR SUSP 200MG/5ML ALPRAZOLAM TBDP 2MG AMLODIPINE-ATORVASTATIN TABS 5-40MG ZOSTAVAX SUSR 19400UNT/0.65ML deductible ACYCLOVIR TABS 400MG ALPROSTADIL SOLN 500MCG/ML AMLODIPINE-ATORVASTATIN TABS 5-80MG ACYCLOVIR TABS 800MG ALTAFLUOR SOLN 0.25-0.4% AMLODIPINE-OLMESARTAN TABS 10-20MG ADAPALENE CREA 0.1% AMANTADINE HCL CAPS 100MG AMLODIPINE-OLMESARTAN TABS 10-40MG ADAPALENE GEL 0.1% AMANTADINE HCL SYRP 50MG/5ML AMLODIPINE-OLMESARTAN TABS 5-20MG ADAPALENE GEL 0.3% AMANTADINE HCL TABS 100MG AMLODIPINE-OLMESARTAN TABS 5-40MG ADAPALENE-BENZOYL GEL 0.1-2.5% AMETHYST TABS 90-20MCG AMLODIPINE-VALSARTAN-HCTZ TABS 10-160-12.5MG ADENOSINE (DIAGNOSTIC) SOLN 3MG/ML AMIKACIN SULFATE SOLN 1GM/4ML AMLODIPINE-VALSARTAN-HCTZ TABS 10-160-25MG ADENOSINE SOLN 12MG/4ML AMIKACIN SULFATE SOLN 500MG/2ML AMLODIPINE-VALSARTAN-HCTZ TABS 10-320-25MG ADENOSINE SOLN 6MG/2ML AMILORIDE HCL TABS 5MG AMLODIPINE-VALSARTAN-HCTZ TABS 5-160-12.5MG ADRUCIL SOLN 2.5GM/50ML AMILORIDE-HYDROCHLOROTHIAZIDE TABS 5-50MG AMLODIPINE-VALSARTAN-HCTZ TABS 5-160-25MG ADRUCIL SOLN 500MG/10ML AMINOACETIC ACID SOLN 1.5% AMMONIUM LACTATE CREA 12% ADRUCIL SOLN 5GM/100ML AMINOCAPROIC ACID SOLN 0.25GM/ML AMMONIUM LACTATE LOTN 12% ALBENDAZOLE TABS 200MG AMINOCAPROIC ACID SOLN 250MG/ML AMNESTEEM CAPS 10MG ALBUTEROL SULFATE NEBU (2.5 MG/3ML)0.083% AMINOCAPROIC ACID TABS 1000MG AMNESTEEM CAPS 20MG ALBUTEROL SULFATE NEBU (5 MG/ML)0.5% AMINOCAPROIC ACID TABS 500MG AMNESTEEM CAPS 40MG ALBUTEROL SULFATE NEBU 0.63MG/3ML AMINOPHYLLINE SOLN 25MG/ML AMOXICILL-CLARITHRO-LANSOPRAZ MISC ALBUTEROL SULFATE NEBU 1.25MG/3ML AMIODARONE HCL SOLN 150MG/3ML AMOXICILLIN CAPS 250MG ALBUTEROL SULFATE SYRP 2MG/5ML AMIODARONE HCL SOLN 450MG/9ML AMOXICILLIN CAPS 500MG ALBUTEROL SULFATE TABS 2MG AMIODARONE HCL SOLN 900MG/18ML AMOXICILLIN SUSR 125MG/5ML ALBUTEROL SULFATE TABS 4MG AMIODARONE HCL TABS 200MG AMOXICILLIN SUSR 200MG/5ML ALCLOMETASONE DIPROPIONATE CREA 0.05% AMITRIPTYLINE HCL TABS 100MG AMOXICILLIN SUSR 250MG/5ML ALCLOMETASONE DIPROPIONATE OINT 0.05% AMITRIPTYLINE HCL TABS 10MG AMOXICILLIN SUSR 400MG/5ML ALENDRONATE SODIUM TABS 10MG AMITRIPTYLINE HCL TABS 150MG AMOXICILLIN TABS 500MG ALENDRONATE SODIUM TABS 35MG AMITRIPTYLINE HCL TABS 25MG AMOXICILLIN TABS 875MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. AMOXICILLIN-POT CLAVULANATE SUSR 200-28.5MG/5ML TABS 25MG BENAZEPRIL HCL TABS 20MG BUDESONIDE ER TB24 9MG AMOXICILLIN-POT CLAVULANATE SUSR 250-62.5MG/5ML ATENOLOL TABS 50MG BENAZEPRIL HCL TABS 40MG BUDESONIDE SUSP 0.25MG/2ML AMOXICILLIN-POT CLAVULANATE SUSR 400-57MG/5ML ATENOLOL-CHLORTHALIDONE TABS 100-25MG BENAZEPRIL HCL TABS 5MG BUDESONIDE SUSP 0.5MG/2ML AMOXICILLIN-POT CLAVULANATE SUSR 600-42.9MG/5ML ATENOLOL-CHLORTHALIDONE TABS 50-25MG BENAZEPRIL-HYDROCHLOROTHIAZIDE TABS 10-12.5MG BUDESONIDE SUSP 1MG/2ML AMOXICILLIN-POT CLAVULANATE TABS 250-125MG ATOMOXETINE HCL CAPS 100MG BENAZEPRIL-HYDROCHLOROTHIAZIDE TABS 20-12.5MG BUMETANIDE SOLN 0.25MG/ML AMOXICILLIN-POT CLAVULANATE TABS 500-125MG ATOMOXETINE HCL CAPS 10MG BENAZEPRIL-HYDROCHLOROTHIAZIDE TABS 20-25MG BUMETANIDE TABS 0.5MG AMOXICILLIN-POT CLAVULANATE TABS 875-125MG ATOMOXETINE HCL CAPS 18MG BENAZEPRIL-HYDROCHLOROTHIAZIDE TABS 5-6.25MG BUMETANIDE TABS 1MG SULFATE TABS 10MG ATOMOXETINE HCL CAPS 25MG BENZEPRO FOAMING CLOTHS MISC 6% BUMETANIDE TABS 2MG AMPHETAMINE SULFATE TABS 5MG ATOMOXETINE HCL CAPS 40MG BENZONATATE CAPS 150MG BUPIVACAINE HCL (PF) SOLN 0.25% AMPHETAMINE-DEXTROAMPHET ER CP24 10MG ATOMOXETINE HCL CAPS 60MG BENZOYL PEROXIDE-ERYTHROMYCIN GEL 5-3% BUPIVACAINE HCL (PF) SOLN 0.5% AMPHETAMINE-DEXTROAMPHET ER CP24 15MG ATOMOXETINE HCL CAPS 80MG BENZPHETAMINE HCL TABS 50MG BUPIVACAINE HCL (PF) SOLN 0.75% AMPHETAMINE-DEXTROAMPHET ER CP24 20MG ATORVASTATIN CALCIUM TABS 10MG BENZTROPINE MESYLATE SOLN 1MG/ML BUPIVACAINE HCL SOLN 0.25% AMPHETAMINE-DEXTROAMPHET ER CP24 25MG ATORVASTATIN CALCIUM TABS 20MG BENZTROPINE MESYLATE TABS 0.5MG BUPIVACAINE HCL SOLN 0.5% AMPHETAMINE-DEXTROAMPHET ER CP24 30MG ATORVASTATIN CALCIUM TABS 40MG BENZTROPINE MESYLATE TABS 1MG BUPIVACAINE SPINAL SOLN 0.75-8.25% AMPHETAMINE-DEXTROAMPHET ER CP24 5MG ATORVASTATIN CALCIUM TABS 80MG BENZTROPINE MESYLATE TABS 2MG BUPIVACAINE-EPINEPHRINE (PF) SOLN 0.25%-1:200000 AMPHETAMINE-DEXTROAMPHETAMINE TABS 10MG ATOVAQUONE SUSP 750MG/5ML BETAMETHASONE DIPROPIONATE AUG CREA 0.05% BUPIVACAINE-EPINEPHRINE (PF) SOLN 0.5%-1:200000 AMPHETAMINE-DEXTROAMPHETAMINE TABS 12.5MG ATOVAQUONE-PROGUANIL HCL TABS 250-100MG BETAMETHASONE DIPROPIONATE AUG LOTN 0.05% BUPIVACAINE-EPINEPHRINE SOLN 0.25%-1:200000 AMPHETAMINE-DEXTROAMPHETAMINE TABS 15MG ATOVAQUONE-PROGUANIL HCL TABS 62.5-25MG BETAMETHASONE DIPROPIONATE AUG OINT 0.05% BUPIVACAINE-EPINEPHRINE SOLN 0.5%-1:200000 AMPHETAMINE-DEXTROAMPHETAMINE TABS 20MG ATRACURIUM BESYLATE SOLN 100MG/10ML BETAMETHASONE DIPROPIONATE CREA 0.05% BUPRENORPHINE HCL SOLN 0.3MG/ML AMPHETAMINE-DEXTROAMPHETAMINE TABS 30MG ATRACURIUM BESYLATE SOLN 50MG/5ML BETAMETHASONE DIPROPIONATE LOTN 0.05% BUPRENORPHINE HCL SUBL 2MG AMPHETAMINE-DEXTROAMPHETAMINE TABS 5MG ATROPINE SULFATE SOLN 8MG/20ML BETAMETHASONE DIPROPIONATE OINT 0.05% BUPRENORPHINE HCL SUBL 8MG AMPHETAMINE-DEXTROAMPHETAMINE TABS 7.5MG ATROPINE SULFATE SOSY 1MG/10ML BETAMETHASONE SOD PHOS & ACET SUSP 6 (3-3)MG/ML BUPRENORPHINE HCL-NALOXONE HCL FILM 12-3MG AMPICILLIN SODIUM SOLR 10GM AV-VITE FB FORTE TABS 2.5-25-2MG BETAMETHASONE VALERATE CREA 0.1% BUPRENORPHINE HCL-NALOXONE HCL FILM 2-0.5MG AMPICILLIN SODIUM SOLR 1GM AVAR CLEANSER EMUL 10-5% BETAMETHASONE VALERATE FOAM 0.12% BUPRENORPHINE HCL-NALOXONE HCL FILM 4-1MG AMPICILLIN SODIUM SOLR 250MG AVITA CREA 0.025% BETAMETHASONE VALERATE LOTN 0.1% BUPRENORPHINE HCL-NALOXONE HCL FILM 8-2MG AMPICILLIN SODIUM SOLR 2GM GEL 15% BETAMETHASONE VALERATE OINT 0.1% BUPRENORPHINE HCL-NALOXONE HCL SUBL 2-0.5MG AMPICILLIN SODIUM SOLR 2GM AZELASTINE HCL SOLN 0.05% HCL SOLN 0.5% BUPRENORPHINE HCL-NALOXONE HCL SUBL 8-2MG AMPICILLIN SODIUM SOLR 500MG AZELASTINE HCL SOLN 0.1% BETAXOLOL HCL TABS 10MG BUPRENORPHINE PTWK 10MCG/HR AMPICILLIN-SULBACTAM SODIUM SOLR 1.5 (1-0.5)GM AZELASTINE HCL SOLN 0.15% BETAXOLOL HCL TABS 20MG BUPRENORPHINE PTWK 15MCG/HR AMPICILLIN-SULBACTAM SODIUM SOLR 15 (10-5)GM AZITHROMYCIN SOLR 500MG BETHANECHOL CHLORIDE TABS 10MG BUPRENORPHINE PTWK 20MCG/HR AMPICILLIN-SULBACTAM SODIUM SOLR 3 (2-1)GM AZITHROMYCIN SUSR 100MG/5ML BETHANECHOL CHLORIDE TABS 25MG BUPRENORPHINE PTWK 5MCG/HR ANAGRELIDE HCL CAPS 0.5MG AZITHROMYCIN SUSR 200MG/5ML BETHANECHOL CHLORIDE TABS 50MG BUPROPION HCL ER (SMOKING DET) TB12 150MG ANAGRELIDE HCL CAPS 1MG AZITHROMYCIN TABS 250MG BETHANECHOL CHLORIDE TABS 5MG BUPROPION HCL ER (SR) TB12 100MG HCL SOLN 0.5% AZITHROMYCIN TABS 500MG BIMATOPROST SOLN 0.03% BUPROPION HCL ER (SR) TB12 150MG APREPITANT CAPS 80 & 125MG AZITHROMYCIN TABS 600MG BIMATOPROST SOLN 0.03% BUPROPION HCL ER (SR) TB12 200MG ARANELLE TABS 0.5/1/0.5-35MG-MCG AZTREONAM SOLR 1GM BIO GLO STRP 1MG BUPROPION HCL ER (XL) TB24 150MG SOLN 1MG/ML AZTREONAM SOLR 2GM FUMARATE TABS 10MG BUPROPION HCL ER (XL) TB24 300MG ARIPIPRAZOLE TABS 10MG BISOPROLOL FUMARATE TABS 5MG BUPROPION HCL TABS 100MG ARIPIPRAZOLE TABS 15MG B BISOPROLOL-HYDROCHLOROTHIAZIDE TABS 10-6.25MG BUPROPION HCL TABS 75MG ARIPIPRAZOLE TABS 20MG BACITRACIN SOLR 50000UNIT BISOPROLOL-HYDROCHLOROTHIAZIDE TABS 2.5-6.25MG HCL TABS 10MG ARIPIPRAZOLE TABS 2MG BACLOFEN SOLN 10MG/20ML BISOPROLOL-HYDROCHLOROTHIAZIDE TABS 5-6.25MG BUSPIRONE HCL TABS 15MG ARIPIPRAZOLE TABS 30MG BACLOFEN SOLN 20000MCG/20ML BP 10-1 EMUL 10-1% BUSPIRONE HCL TABS 30MG ARIPIPRAZOLE TABS 5MG BACLOFEN SOLN 40MG/20ML BP FOAM FOAM 5.3% BUSPIRONE HCL TABS 5MG ARMODAFINIL TABS 150MG BACLOFEN TABS 10MG BP FOAM FOAM 9.8% BUSPIRONE HCL TABS 7.5MG ARMODAFINIL TABS 200MG BACLOFEN TABS 20MG TARTRATE SOLN 0.15% BUTALBITAL-ACETAMINOPHEN TABS 50-300MG ARMODAFINIL TABS 250MG BALANCED SALT SOLN BRIMONIDINE TARTRATE SOLN 0.2% BUTALBITAL-ACETAMINOPHEN TABS 50-325MG ARMODAFINIL TABS 50MG BALSALAZIDE DISODIUM CAPS 750MG MESYLATE CAPS 5MG BUTALBITAL-APAP-CAFF-COD CAPS 50-300-40-30MG ASCORBIC ACID SOLN 500MG/ML BALZIVA TABS 0.4-35MG-MCG BROMOCRIPTINE MESYLATE TABS 2.5MG BUTALBITAL-APAP-CAFF-COD CAPS 50-325-40-30MG ATENOLOL TABS 100MG BENAZEPRIL HCL TABS 10MG BUDESONIDE CPEP 3MG BUTALBITAL-APAP-CAFFEINE CAPS 50-300-40MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. BUTALBITAL-APAP-CAFFEINE CAPS 50-325-40MG CARBIDOPA-LEVODOPA TBDP 25-100MG CEFTRIAXONE SODIUM SOLR 2GM TABS 200MG BUTALBITAL-APAP-CAFFEINE TABS 50-325-40MG CARBIDOPA-LEVODOPA TBDP 25-250MG CEFTRIAXONE SODIUM SOLR 500MG CIMETIDINE TABS 300MG BUTALBITAL-ASA-CAFF-CODEINE CAPS 50-325-40-30MG CARBINOXAMINE MALEATE SOLN 4MG/5ML CEFUROXIME AXETIL TABS 250MG CIMETIDINE TABS 400MG BUTALBITAL-ASPIRIN-CAFFEINE CAPS 50-325-40MG CARBINOXAMINE MALEATE TABS 4MG CEFUROXIME AXETIL TABS 500MG CIMETIDINE TABS 800MG BUTORPHANOL TARTRATE SOLN 10MG/ML CARDIOPLEGIC SOLN CEFUROXIME SODIUM SOLR 1.5GM CINACALCET HCL TABS 30MG BUTORPHANOL TARTRATE SOLN 2MG/ML PHOSPHATE ER CP24 10MG CEFUROXIME SODIUM SOLR 7.5GM CINACALCET HCL TABS 60MG CARVEDILOL PHOSPHATE ER CP24 20MG CEFUROXIME SODIUM SOLR 750MG CINACALCET HCL TABS 90MG C CARVEDILOL PHOSPHATE ER CP24 40MG CELACYN GEL CIPROFLOXACIN HCL SOLN 0.3% TABS 0.5MG CARVEDILOL PHOSPHATE ER CP24 80MG CELECOXIB CAPS 100MG CIPROFLOXACIN HCL TABS 250MG CAFFEINE CITRATE SOLN 60MG/3ML CARVEDILOL TABS 12.5MG CELECOXIB CAPS 200MG CIPROFLOXACIN HCL TABS 750MG CAFFEINE CITRATE SOLN 60MG/3ML CARVEDILOL TABS 25MG CELECOXIB CAPS 400MG CIPROFLOXACIN IN D5W SOLN 200MG/100ML CALCIPOTRIENE CREA 0.005% CARVEDILOL TABS 3.125MG CELECOXIB CAPS 50MG CIPROFLOXACIN IN D5W SOLN 400MG/200ML CALCIPOTRIENE OINT 0.005% CARVEDILOL TABS 6.25MG CEPHALEXIN CAPS 250MG CIPROFLOXACIN SUSR 500 MG/5ML(10%) CALCIPOTRIENE SOLN 0.005% CEFACLOR CAPS 250MG CEPHALEXIN CAPS 500MG CISATRACURIUM BESYLATE (PF) SOLN 10MG/5ML CALCIPOTRIENE-BETAMETH DIPROP OINT 0.005-0.064% CEFACLOR CAPS 500MG CEPHALEXIN CAPS 750MG CISATRACURIUM BESYLATE (PF) SOLN 200MG/20ML CALCITONIN (SALMON) SOLN 200UNIT/ACT CEFADROXIL CAPS 500MG CEPHALEXIN SUSR 125MG/5ML CISATRACURIUM BESYLATE SOLN 20MG/10ML CALCITRIOL CAPS 0.25MCG CEFADROXIL SUSR 250MG/5ML CEPHALEXIN SUSR 250MG/5ML CITALOPRAM HYDROBROMIDE SOLN 10MG/5ML CALCITRIOL CAPS 0.5MCG CEFADROXIL SUSR 500MG/5ML CETIRIZINE HCL SOLN 5MG/5ML CITALOPRAM HYDROBROMIDE TABS 10MG CALCITRIOL SOLN 1MCG/ML CEFADROXIL TABS 1GM CEVIMELINE HCL CAPS 30MG CITALOPRAM HYDROBROMIDE TABS 20MG CALCIUM ACETATE (PHOS BINDER) CAPS 667MG CEFAZOLIN SODIUM SOLR 10GM CHLORDIAZEPOXIDE HCL CAPS 10MG CITALOPRAM HYDROBROMIDE TABS 40MG CALCIUM ACETATE (PHOS BINDER) TABS 667MG CEFAZOLIN SODIUM SOLR 1GM CHLORDIAZEPOXIDE HCL CAPS 25MG CLARAVIS CAPS 30MG CALCIUM CHLORIDE SOLN 10% CEFAZOLIN SODIUM SOLR 500MG CHLORDIAZEPOXIDE HCL CAPS 5MG CLARITHROMYCIN ER TB24 500MG SOLN 10% CEFDINIR CAPS 300MG CHLORDIAZEPOXIDE-CLIDINIUM CAPS 5-2.5MG CLARITHROMYCIN TABS 250MG CAMRESE LO TABS 0.1-0.02 & 0.01MG CEFDINIR SUSR 125MG/5ML GLUCONATE SOLN 0.12% CLINDACIN-P SWAB 1% CAMRESE TABS 0.15-0.03 &0.01MG CEFDINIR SUSR 250MG/5ML CHLOROPROCAINE HCL (PF) SOLN 2% CLINDAMYCIN HCL CAPS 150MG CANDESARTAN CILEXETIL TABS 16MG CEFEPIME HCL SOLR 1GM CHLOROPROCAINE HCL (PF) SOLN 3% CLINDAMYCIN HCL CAPS 300MG CANDESARTAN CILEXETIL TABS 32MG CEFEPIME HCL SOLR 2GM CHLOROQUINE PHOSPHATE TABS 500MG CLINDAMYCIN HCL CAPS 75MG CANDESARTAN CILEXETIL TABS 4MG CEFIXIME CAPS 400MG CHLOROTHIAZIDE SODIUM SOLR 500MG CLINDAMYCIN PALMITATE HCL SOLR 75MG/5ML CANDESARTAN CILEXETIL TABS 8MG CEFIXIME SUSR 100MG/5ML HCL TABS 100MG CLINDAMYCIN PHOS-BENZOYL PEROX GEL 1-5% CANDESARTAN CILEXETIL-HCTZ TABS 16-12.5MG CEFIXIME SUSR 200MG/5ML CHLORPROMAZINE HCL TABS 10MG CLINDAMYCIN PHOS-BENZOYL PEROX GEL 1.2-2.5% CANDESARTAN CILEXETIL-HCTZ TABS 32-12.5MG CEFOTAXIME SODIUM SOLR 1GM CHLORPROMAZINE HCL TABS 200MG CLINDAMYCIN PHOS-BENZOYL PEROX GEL 1.2-5% CANDESARTAN CILEXETIL-HCTZ TABS 32-25MG CEFOTETAN DISODIUM SOLR 1GM CHLORPROMAZINE HCL TABS 25MG CLINDAMYCIN PHOSPHATE CREA 2% CAPTOPRIL TABS 100MG CEFOTETAN DISODIUM SOLR 2GM CHLORPROMAZINE HCL TABS 50MG CLINDAMYCIN PHOSPHATE FOAM 1% CAPTOPRIL TABS 12.5MG CEFOXITIN SODIUM SOLR 10GM CHLORTHALIDONE TABS 25MG CLINDAMYCIN PHOSPHATE GEL 1% CAPTOPRIL TABS 25MG CEFOXITIN SODIUM SOLR 1GM CHLORTHALIDONE TABS 50MG CLINDAMYCIN PHOSPHATE IN D5W SOLN 300MG/50ML CAPTOPRIL TABS 50MG CEFOXITIN SODIUM SOLR 2GM CHOLESTYRAMINE LIGHT PACK 4GM CLINDAMYCIN PHOSPHATE IN D5W SOLN 600MG/50ML CARBAMAZEPINE CHEW 100MG CEFPODOXIME PROXETIL SUSR 100MG/5ML CHOLESTYRAMINE LIGHT POWD 4GM/DOSE CLINDAMYCIN PHOSPHATE IN D5W SOLN 900MG/50ML CARBAMAZEPINE ER CP12 100MG CEFPODOXIME PROXETIL SUSR 50MG/5ML CHOLESTYRAMINE PACK 4GM CLINDAMYCIN PHOSPHATE LOTN 1% CARBAMAZEPINE ER TB12 100MG CEFPODOXIME PROXETIL TABS 100MG CHOLESTYRAMINE POWD 4GM/DOSE CLINDAMYCIN PHOSPHATE SOLN 1% CARBAMAZEPINE ER TB12 200MG CEFPODOXIME PROXETIL TABS 200MG CHOLINE-MAG TRISALICYLATE LIQD 500MG/5ML CLINDAMYCIN PHOSPHATE SOLN 300MG/2ML CARBAMAZEPINE ER TB12 400MG CEFPROZIL SUSR 125MG/5ML GEL 0.77% CLINDAMYCIN PHOSPHATE SOLN 300MG/2ML CARBAMAZEPINE SUSP 100MG/5ML CEFPROZIL SUSR 250MG/5ML CICLOPIROX OLAMINE CREA 0.77% CLINDAMYCIN PHOSPHATE SOLN 600MG/4ML CARBIDOPA TABS 25MG CEFPROZIL TABS 250MG CICLOPIROX OLAMINE SUSP 0.77% CLINDAMYCIN PHOSPHATE SOLN 600MG/4ML CARBIDOPA-LEVODOPA ER TBCR 25-100MG CEFPROZIL TABS 500MG CICLOPIROX SHAM 1% CLINDAMYCIN PHOSPHATE SOLN 9000MG/60ML CARBIDOPA-LEVODOPA ER TBCR 50-200MG CEFTRIAXONE SODIUM SOLR 10GM CICLOPIROX SOLN 8% CLINDAMYCIN PHOSPHATE SOLN 900MG/6ML CARBIDOPA-LEVODOPA TABS 10-100MG CEFTRIAXONE SODIUM SOLR 1GM CICLOPIROX TREATMENT KIT 8% CLINDAMYCIN PHOSPHATE SOLN 900MG/6ML CARBIDOPA-LEVODOPA TABS 25-100MG CEFTRIAXONE SODIUM SOLR 1GM CIDOFOVIR SOLN 75MG/ML CLINDAMYCIN- GEL 1.2-0.025% CARBIDOPA-LEVODOPA TABS 25-250MG CEFTRIAXONE SODIUM SOLR 250MG CILOSTAZOL TABS 100MG CLOBAZAM SUSP 2.5MG/ML CARBIDOPA-LEVODOPA TBDP 10-100MG CEFTRIAXONE SODIUM SOLR 2GM CILOSTAZOL TABS 50MG CLOBAZAM TABS 10MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. HCL TABS 100MG CLOBAZAM TABS 20MG COLCHICINE-PROBENECID TABS 0.5-500MG DEXMETHYLPHENIDATE HCL ER CP24 5MG DESIPRAMINE HCL TABS 10MG CLOBETASOL PROPIONATE CREA 0.05% COLESEVELAM HCL PACK 3.75GM DEXMETHYLPHENIDATE HCL TABS 10MG DESIPRAMINE HCL TABS 150MG CLOBETASOL PROPIONATE E CREA 0.05% COLESEVELAM HCL TABS 625MG DEXMETHYLPHENIDATE HCL TABS 2.5MG DESIPRAMINE HCL TABS 25MG CLOBETASOL PROPIONATE EMULSION FOAM 0.05% COLESTIPOL HCL GRAN 5GM DEXMETHYLPHENIDATE HCL TABS 5MG DESIPRAMINE HCL TABS 50MG CLOBETASOL PROPIONATE FOAM 0.05% COLESTIPOL HCL PACK 5GM DEXTROAMPHETAMINE SULFATE ER CP24 10MG DESIPRAMINE HCL TABS 75MG CLOBETASOL PROPIONATE GEL 0.05% COLESTIPOL HCL TABS 1GM DEXTROAMPHETAMINE SULFATE ER CP24 15MG TROC 10MG CLOBETASOL PROPIONATE LIQD 0.05% COLISTIMETHATE SODIUM (CBA) SOLR 150MG DEXTROAMPHETAMINE SULFATE ER CP24 5MG DESLORATADINE TABS 5MG CLOBETASOL PROPIONATE LOTN 0.05% COLOCORT ENEM 100MG/60ML DEXTROAMPHETAMINE SULFATE SOLN 5MG/5ML DESMOPRESSIN ACE SPRAY REFRIG SOLN 0.01% CLOBETASOL PROPIONATE OINT 0.05% COMPRO SUPP 25MG DEXTROAMPHETAMINE SULFATE TABS 10MG DESMOPRESSIN ACETATE SOLN 4MCG/ML CLOBETASOL PROPIONATE SHAM 0.05% CORVITA 150 TABS 150-1.25MG DEXTROAMPHETAMINE SULFATE TABS 5MG DESMOPRESSIN ACETATE SPRAY SOLN 0.01% CLOBETASOL PROPIONATE SOLN 0.05% COVARYX HS TABS 0.625-1.25MG DEXTROSE IN LACTATED RINGERS SOLN 5% DESMOPRESSIN ACETATE TABS 0.1MG HCL CAPS 25MG COVARYX TABS 1.25-2.5MG DEXTROSE SOLN 10% DESMOPRESSIN ACETATE TABS 0.2MG CLOMIPRAMINE HCL CAPS 50MG CROMOLYN SODIUM CONC 100MG/5ML DEXTROSE SOLN 5% DESOGESTREL-ETHINYL ESTRADIOL TABS 0.15-0.02/0.01MG (21/5) CLOMIPRAMINE HCL CAPS 75MG CROMOLYN SODIUM NEBU 20MG/2ML DEXTROSE SOLN 50% DESONIDE CREA 0.05% CLONAZEPAM TABS 0.5MG CROMOLYN SODIUM SOLN 4% DEXTROSE SOLN 70% DESONIDE LOTN 0.05% CLONAZEPAM TABS 1MG CROTAN LOTN 10% DEXTROSE-NACL SOLN 5-0.2% DESONIDE OINT 0.05% CLONAZEPAM TABS 2MG CRYSELLE-28 TABS 0.3-30MG-MCG DEXTROSE-NACL SOLN 5-0.33% DESOXIMETASONE CREA 0.25% CLONAZEPAM TBDP 0.125MG CYANOCOBALAMIN SOLN 1000MCG/ML DEXTROSE-NACL SOLN 5-0.45% DESOXIMETASONE GEL 0.05% CLONAZEPAM TBDP 0.25MG HCL ER CP24 15MG DEXTROSE-NACL SOLN 5-0.9% DESOXIMETASONE LIQD 0.25% CLONAZEPAM TBDP 0.5MG CYCLOBENZAPRINE HCL ER CP24 30MG DIAZEPAM INTENSOL CONC 5MG/ML DESOXIMETASONE OINT 0.05% CLONAZEPAM TBDP 1MG CYCLOBENZAPRINE HCL TABS 10MG DIAZEPAM SOLN 5MG/ML DESOXIMETASONE OINT 0.25% CLONAZEPAM TBDP 2MG CYCLOBENZAPRINE HCL TABS 5MG DIAZEPAM TABS 10MG DESVENLAFAXINE SUCCINATE ER TB24 100MG HCL (ANALGESIA) SOLN 100MCG/ML CYCLOBENZAPRINE HCL TABS 7.5MG DIAZEPAM TABS 2MG DESVENLAFAXINE SUCCINATE ER TB24 25MG CLONIDINE HCL (ANALGESIA) SOLN 500MCG/ML CYCLOPENTOLATE HCL SOLN 0.5% DIAZEPAM TABS 5MG DESVENLAFAXINE SUCCINATE ER TB24 50MG CLONIDINE HCL ER TB12 0.1MG CYCLOPENTOLATE HCL SOLN 1% DICLOFENAC POTASSIUM TABS 50MG DEXAMETHASONE ELIX 0.5MG/5ML CLONIDINE HCL TABS 0.1MG CYCLOPENTOLATE HCL SOLN 2% DICLOFENAC SODIUM ER TB24 100MG DEXAMETHASONE SOD PHOSPHATE PF SOLN 10MG/ML CLONIDINE HCL TABS 0.2MG HCL SYRP 2MG/5ML DICLOFENAC SODIUM GEL 1% DEXAMETHASONE SODIUM PHOSPHATE SOLN 100MG/10ML CLONIDINE HCL TABS 0.3MG CYPROHEPTADINE HCL TABS 4MG DICLOFENAC SODIUM GEL 3% DEXAMETHASONE SODIUM PHOSPHATE SOLN 120MG/30ML CLONIDINE PTWK 0.1MG/24HR CYTRA K CRYSTALS PACK 3300-1002MG DICLOFENAC SODIUM SOLN 0.1% DEXAMETHASONE SODIUM PHOSPHATE SOLN 20MG/5ML CLONIDINE PTWK 0.2MG/24HR DICLOFENAC SODIUM SOLN 1.5% DEXAMETHASONE SODIUM PHOSPHATE SOLN 4MG/ML CLONIDINE PTWK 0.3MG/24HR D DICLOFENAC SODIUM TBEC 25MG DEXAMETHASONE TABS 0.5MG CLOPIDOGREL BISULFATE TABS 300MG CAPS 100MG DICLOFENAC SODIUM TBEC 50MG DEXAMETHASONE TABS 0.75MG CLOPIDOGREL BISULFATE TABS 75MG DANAZOL CAPS 200MG DICLOFENAC SODIUM TBEC 75MG DEXAMETHASONE TABS 1.5MG CLORAZEPATE DIPOTASSIUM TABS 15MG DANAZOL CAPS 50MG DICLOFENAC-MISOPROSTOL TBEC 50-0.2MG DEXAMETHASONE TABS 4MG CLORAZEPATE DIPOTASSIUM TABS 3.75MG DANTROLENE SODIUM CAPS 100MG DICLOFENAC-MISOPROSTOL TBEC 75-0.2MG DEXAMETHASONE TABS 6MG CLORAZEPATE DIPOTASSIUM TABS 7.5MG DANTROLENE SODIUM CAPS 25MG DICLOXACILLIN SODIUM CAPS 250MG DEXAMETHASONE TBPK 1.5MG (35) CLOTRIMAZOLE CREA 1% DANTROLENE SODIUM CAPS 50MG DICLOXACILLIN SODIUM CAPS 500MG DEXAMETHASONE TBPK 1.5MG (51) CLOTRIMAZOLE SOLN 1% DAPSONE GEL 5% DICYCLOMINE HCL CAPS 10MG HCL IN NACL SOLN 200MCG/50ML CLOTRIMAZOLE TROC 10MG DAPSONE TABS 100MG DICYCLOMINE HCL SOLN 10MG/5ML DEXMEDETOMIDINE HCL IN NACL SOLN 400MCG/100ML CLOTRIMAZOLE-BETAMETHASONE CREA 1-0.05% DAPSONE TABS 25MG DICYCLOMINE HCL SOLN 10MG/ML DEXMEDETOMIDINE HCL IN NACL SOLN 80MCG/20ML CLOTRIMAZOLE-BETAMETHASONE LOTN 1-0.05% DAPTOMYCIN SOLR 500MG DICYCLOMINE HCL TABS 20MG DEXMEDETOMIDINE HCL SOLN 200MCG/2ML TABS 100MG DARIFENACIN HYDROBROMIDE ER TB24 15MG DIDANOSINE CPDR 200MG DEXMETHYLPHENIDATE HCL ER CP24 10MG CLOZAPINE TABS 200MG DARIFENACIN HYDROBROMIDE ER TB24 7.5MG DIDANOSINE CPDR 250MG DEXMETHYLPHENIDATE HCL ER CP24 15MG CLOZAPINE TABS 25MG DECITABINE SOLR 50MG DIDANOSINE CPDR 400MG DEXMETHYLPHENIDATE HCL ER CP24 20MG CLOZAPINE TABS 50MG DEFEROXAMINE MESYLATE SOLR 2GM DIETHYLPROPION HCL TABS 25MG DEXMETHYLPHENIDATE HCL ER CP24 25MG CLOZAPINE TBDP 100MG DEMECLOCYCLINE HCL TABS 150MG DIFLORASONE DIACETATE OINT 0.05% DEXMETHYLPHENIDATE HCL ER CP24 30MG CLOZAPINE TBDP 12.5MG DEMECLOCYCLINE HCL TABS 300MG DIFLUNISAL TABS 500MG DEXMETHYLPHENIDATE HCL ER CP24 35MG CLOZAPINE TBDP 25MG DESFLURANE SOLN DIGOXIN SOLN 0.25MG/ML DEXMETHYLPHENIDATE HCL ER CP24 40MG CODEINE SULFATE TABS 30MG DIGOXIN TABS 125MCG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. DIGOXIN TABS 250MCG HCL SOLN 40MG/ML DROSPIRENONE-ETHINYL ESTRADIOL TABS 3-0.03MG ESCITALOPRAM OXALATE TABS 10MG MESYLATE SOLN 1MG/ML DOPAMINE IN D5W SOLN 0.8-5MG/ML-% DULOXETINE HCL CPEP 20MG ESCITALOPRAM OXALATE TABS 20MG DILTIAZEM HCL ER BEADS CP24 240MG DOPAMINE IN D5W SOLN 1.6-5MG/ML-% DULOXETINE HCL CPEP 30MG ESCITALOPRAM OXALATE TABS 5MG DILTIAZEM HCL ER BEADS CP24 300MG DOPAMINE IN D5W SOLN 3.2-5MG/ML-% DULOXETINE HCL CPEP 40MG ESMOLOL HCL SOLN 100MG/10ML DILTIAZEM HCL ER BEADS CP24 360MG DORZOLAMIDE HCL SOLN 2% DULOXETINE HCL CPEP 60MG ESMOLOL HCL-SODIUM CHLORIDE SOLN 2000MG/100ML DILTIAZEM HCL ER BEADS CP24 420MG DORZOLAMIDE HCL- MAL PF SOLN 2-0.5% CAPS 0.5MG ESMOLOL HCL-SODIUM CHLORIDE SOLN 2500MG/250ML DILTIAZEM HCL ER COATED BEADS CP24 120MG DORZOLAMIDE HCL-TIMOLOL MAL SOLN 22.3-6.8MG/ML DUTASTERIDE- HCL CAPS 0.5-0.4MG ESOMEPRAZOLE MAGNESIUM CPDR 20MG DILTIAZEM HCL ER COATED BEADS CP24 180MG MESYLATE TABS 1MG ESOMEPRAZOLE MAGNESIUM CPDR 40MG DILTIAZEM HCL ER COATED BEADS CP24 240MG DOXAZOSIN MESYLATE TABS 2MG E ESOMEPRAZOLE SODIUM SOLR 40MG DILTIAZEM HCL ER COATED BEADS CP24 300MG DOXAZOSIN MESYLATE TABS 4MG ED-SPAZ TBDP 0.125MG ESTAZOLAM TABS 1MG DILTIAZEM HCL ER COATED BEADS CP24 360MG DOXAZOSIN MESYLATE TABS 8MG ELETRIPTAN HYDROBROMIDE TABS 20MG ESTAZOLAM TABS 2MG DILTIAZEM HCL ER CP12 120MG HCL CAPS 100MG ELETRIPTAN HYDROBROMIDE TABS 40MG ESTRADIOL CREA 0.1MG/GM DILTIAZEM HCL ER CP12 60MG DOXEPIN HCL CAPS 10MG ENALAPRIL MALEATE TABS 10MG ESTRADIOL PTTW 0.025MG/24HR DILTIAZEM HCL ER CP12 90MG DOXEPIN HCL CAPS 25MG ENALAPRIL MALEATE TABS 2.5MG ESTRADIOL PTTW 0.0375MG/24HR DILTIAZEM HCL ER CP24 180MG DOXEPIN HCL CAPS 50MG ENALAPRIL MALEATE TABS 20MG ESTRADIOL PTTW 0.05MG/24HR DILTIAZEM HCL ER CP24 240MG DOXEPIN HCL CAPS 75MG ENALAPRIL MALEATE TABS 5MG ESTRADIOL PTTW 0.075MG/24HR DILTIAZEM HCL SOLN 125MG/25ML DOXEPIN HCL CONC 10MG/ML ENALAPRIL-HYDROCHLOROTHIAZIDE TABS 10-25MG ESTRADIOL PTTW 0.1MG/24HR DILTIAZEM HCL SOLN 25MG/5ML DOXERCALCIFEROL CAPS 0.5MCG ENALAPRIL-HYDROCHLOROTHIAZIDE TABS 5-12.5MG ESTRADIOL PTWK 0.025MG/24HR DILTIAZEM HCL SOLN 50MG/10ML DOXERCALCIFEROL CAPS 1MCG ENALAPRILAT INJ 1.25MG/ML ESTRADIOL PTWK 0.0375MG/24HR DILTIAZEM HCL TABS 120MG DOXERCALCIFEROL CAPS 2.5MCG ENPRESSE-28 TABS ESTRADIOL PTWK 0.05MG/24HR DILTIAZEM HCL TABS 30MG DOXERCALCIFEROL SOLN 4MCG/2ML ENTACAPONE TABS 200MG ESTRADIOL PTWK 0.06MG/24HR DILTIAZEM HCL TABS 60MG DOXY 100 SOLR 100MG ENTECAVIR TABS 0.5MG ESTRADIOL PTWK 0.075MG/24HR DILTIAZEM HCL TABS 90MG DOXYCYCLINE HYCLATE CAPS 100MG ENTECAVIR TABS 1MG ESTRADIOL PTWK 0.1MG/24HR DIPHENHYDRAMINE HCL ELIX 12.5MG/5ML DOXYCYCLINE HYCLATE CAPS 50MG SULFATE SOLN 50MG/ML ESTRADIOL TABS 0.5MG DIPHENHYDRAMINE HCL SOLN 50MG/ML DOXYCYCLINE HYCLATE TABS 100MG EPINASTINE HCL SOLN 0.05% ESTRADIOL TABS 10MCG DIPHENOXYLATE-ATROPINE TABS 2.5-0.025MG DOXYCYCLINE HYCLATE TABS 150MG EPINEPHRINE PF SOLN 1MG/ML ESTRADIOL TABS 1MG DIPYRIDAMOLE TABS 25MG DOXYCYCLINE HYCLATE TABS 20MG EPINEPHRINE PF SOSY 1MG/10ML ESTRADIOL TABS 2MG DIPYRIDAMOLE TABS 50MG DOXYCYCLINE HYCLATE TABS 75MG EPINEPHRINE SOAJ 0.15MG/0.3ML OIL 20MG/ML DIPYRIDAMOLE TABS 75MG DOXYCYCLINE HYCLATE TBEC 100MG EPINEPHRINE SOAJ 0.3MG/0.3ML ESTRADIOL VALERATE OIL 40MG/ML DISULFIRAM TABS 250MG DOXYCYCLINE HYCLATE TBEC 150MG EPITOL TABS 200MG ESZOPICLONE TABS 1MG DISULFIRAM TABS 500MG DOXYCYCLINE HYCLATE TBEC 200MG EPLERENONE TABS 25MG ESZOPICLONE TABS 2MG DIVALPROEX SODIUM CSDR 125MG DOXYCYCLINE HYCLATE TBEC 50MG EPLERENONE TABS 50MG ESZOPICLONE TABS 3MG DIVALPROEX SODIUM ER TB24 250MG DOXYCYCLINE HYCLATE TBEC 75MG EPTIFIBATIDE SOLN 200MG/100ML ETHACRYNATE SODIUM SOLR 50MG DIVALPROEX SODIUM ER TB24 500MG DOXYCYCLINE MONOHYDRATE CAPS 100MG EPTIFIBATIDE SOLN 20MG/10ML ETHACRYNIC ACID TABS 25MG DIVALPROEX SODIUM TBEC 125MG DOXYCYCLINE MONOHYDRATE CAPS 150MG EPTIFIBATIDE SOLN 75MG/100ML ETHAMBUTOL HCL TABS 100MG DIVALPROEX SODIUM TBEC 250MG DOXYCYCLINE MONOHYDRATE CAPS 50MG -CAFFEINE TABS 1-100MG ETHAMBUTOL HCL TABS 400MG DIVALPROEX SODIUM TBEC 500MG DOXYCYCLINE MONOHYDRATE CAPS 75MG ERTAPENEM SODIUM SOLR 1GM ETHOSUXIMIDE CAPS 250MG HCL SOLN 250MG/20ML DOXYCYCLINE MONOHYDRATE SUSR 25MG/5ML ERY PADS 2% ETHOSUXIMIDE SOLN 250MG/5ML DOBUTAMINE IN D5W SOLN 1-5MG/ML-% DOXYCYCLINE MONOHYDRATE TABS 100MG ERY-TAB TBEC 250MG ETHYNODIOL DIAC-ETH ESTRADIOL TABS 1-35MG-MCG DOBUTAMINE IN D5W SOLN 2MG/ML DOXYCYCLINE MONOHYDRATE TABS 150MG ERY-TAB TBEC 333MG ETODOLAC CAPS 200MG DOBUTAMINE IN D5W SOLN 4-5MG/ML-% DOXYCYCLINE MONOHYDRATE TABS 50MG ERYTHROMYCIN BASE CPEP 250MG ETODOLAC CAPS 300MG DOFETILIDE CAPS 125MCG DOXYCYCLINE MONOHYDRATE TABS 75MG ERYTHROMYCIN BASE TABS 250MG ETODOLAC ER TB24 400MG DOFETILIDE CAPS 250MCG DOXYLAMINE-PYRIDOXINE TBEC 10-10MG ERYTHROMYCIN BASE TABS 500MG ETODOLAC ER TB24 500MG DOFETILIDE CAPS 500MCG DRONABINOL CAPS 10MG ERYTHROMYCIN ETHYLSUCCINATE SUSR 200MG/5ML ETODOLAC ER TB24 600MG DONEPEZIL HCL TABS 10MG DRONABINOL CAPS 2.5MG ERYTHROMYCIN ETHYLSUCCINATE SUSR 400MG/5ML ETODOLAC TABS 400MG DONEPEZIL HCL TABS 23MG DRONABINOL CAPS 5MG ERYTHROMYCIN GEL 2% ETODOLAC TABS 500MG DONEPEZIL HCL TABS 5MG DROPERIDOL SOLN 2.5MG/ML ERYTHROMYCIN SOLN 2% ETOMIDATE SOLN 2MG/ML DONEPEZIL HCL TBDP 10MG DROSPIREN-ETH ESTRAD-LEVOMEFOL TABS 3-0.02-0.451MG ERYTHROMYCIN TBEC 500MG EZETIMIBE TABS 10MG DONEPEZIL HCL TBDP 5MG DROSPIREN-ETH ESTRAD-LEVOMEFOL TABS 3-0.03-0.451MG ESCITALOPRAM OXALATE SOLN 5MG/5ML EZETIMIBE-SIMVASTATIN TABS 10-10MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. EZETIMIBE-SIMVASTATIN TABS 10-20MG FENTANYL PT72 37.5MCG/HR FLUOXETINE HCL TABS 10MG GALANTAMINE HYDROBROMIDE ER CP24 8MG EZETIMIBE-SIMVASTATIN TABS 10-40MG FENTANYL PT72 50MCG/HR FLUOXETINE HCL TABS 20MG GALANTAMINE HYDROBROMIDE TABS 12MG EZETIMIBE-SIMVASTATIN TABS 10-80MG FENTANYL PT72 62.5MCG/HR FLUOXETINE HCL TABS 60MG GALANTAMINE HYDROBROMIDE TABS 4MG FENTANYL PT72 75MCG/HR DECANOATE SOLN 25MG/ML GALANTAMINE HYDROBROMIDE TABS 8MG F FENTANYL PT72 87.5MCG/HR FLURANDRENOLIDE CREA 0.05% GATIFLOXACIN SOLN 0.5% FA-VITAMIN B-6-VITAMIN B-12 TABS 2.2-25-0.5MG FERROCITE PLUS TABS 106-1MG FLURANDRENOLIDE LOTN 0.05% GAVILYTE-C SOLR 240GM FAMCICLOVIR TABS 125MG TABS 1MG FLURANDRENOLIDE OINT 0.05% GEMCITABINE HCL SOLN 1GM/26.3ML FAMCICLOVIR TABS 250MG FINASTERIDE TABS 5MG FLURBIPROFEN TABS 100MG GEMCITABINE HCL SOLN 200MG/5.26ML FAMCICLOVIR TABS 500MG FLAVOXATE HCL TABS 100MG FLURBIPROFEN TABS 50MG GEMCITABINE HCL SOLN 2GM/52.6ML FAMOTIDINE SOLN 200MG/20ML FLECAINIDE ACETATE TABS 100MG CAPS 125MG GENTAMICIN IN SALINE SOLN 1.2-0.9MG/ML-% FAMOTIDINE SOLN 20MG/2ML FLECAINIDE ACETATE TABS 150MG FLUTICASONE PROPIONATE CREA 0.05% GENTAMICIN SULFATE CREA 0.1% FAMOTIDINE SOLN 40MG/4ML FLECAINIDE ACETATE TABS 50MG FLUTICASONE PROPIONATE LOTN 0.05% GENTAMICIN SULFATE OINT 0.1% FAMOTIDINE TABS 20MG FLUCAINE SOLN 0.25-0.5% FLUTICASONE PROPIONATE OINT 0.005% GENTAMICIN SULFATE SOLN 0.3% FAMOTIDINE TABS 40MG FLUCONAZOLE IN SODIUM CHLORIDE SOLN 200-0.9MG/100ML-% FLUTICASONE PROPIONATE SUSP 50MCG/ACT GENTAMICIN SULFATE SOLN 40MG/ML FEBUXOSTAT TABS 40MG FLUCONAZOLE IN SODIUM CHLORIDE SOLN 400-0.9MG/200ML-% FLUVASTATIN SODIUM CAPS 20MG GIANVI TABS 3-0.02MG FEBUXOSTAT TABS 80MG FLUCONAZOLE SUSR 10MG/ML FLUVASTATIN SODIUM CAPS 40MG GLIMEPIRIDE TABS 1MG FELBAMATE SUSP 600MG/5ML FLUCONAZOLE SUSR 40MG/ML FLUVASTATIN SODIUM ER TB24 80MG GLIMEPIRIDE TABS 2MG FELBAMATE TABS 400MG FLUCONAZOLE TABS 100MG FLUVOXAMINE MALEATE ER CP24 100MG GLIMEPIRIDE TABS 4MG FELBAMATE TABS 600MG FLUCONAZOLE TABS 150MG FLUVOXAMINE MALEATE ER CP24 150MG GLIPIZIDE ER TB24 10MG FELODIPINE ER TB24 10MG FLUCONAZOLE TABS 200MG FLUVOXAMINE MALEATE TABS 100MG GLIPIZIDE ER TB24 2.5MG FELODIPINE ER TB24 2.5MG FLUCONAZOLE TABS 50MG FLUVOXAMINE MALEATE TABS 25MG GLIPIZIDE ER TB24 5MG FELODIPINE ER TB24 5MG FLUCYTOSINE CAPS 250MG FLUVOXAMINE MALEATE TABS 50MG GLIPIZIDE TABS 10MG FENOFIBRATE MICRONIZED CAPS 130MG FLUCYTOSINE CAPS 500MG FOLBEE PLUS TABS GLIPIZIDE TABS 5MG FENOFIBRATE MICRONIZED CAPS 134MG FLUDROCORTISONE ACETATE TABS 0.1MG FOLBEE TABS 2.5-25-1MG GLIPIZIDE-METFORMIN HCL TABS 2.5-250MG FENOFIBRATE MICRONIZED CAPS 200MG FLUMAZENIL SOLN 0.5MG/5ML FOLIC ACID TABS 1MG GLIPIZIDE-METFORMIN HCL TABS 2.5-500MG FENOFIBRATE MICRONIZED CAPS 43MG FLUMAZENIL SOLN 1MG/10ML FOMEPIZOLE SOLN 1.5GM/1.5ML GLIPIZIDE-METFORMIN HCL TABS 5-500MG FENOFIBRATE MICRONIZED CAPS 67MG FLUOCINOLONE ACETONIDE BODY OIL 0.01% FOSINOPRIL SODIUM TABS 10MG GLYBURIDE MICRONIZED TABS 1.5MG FENOFIBRATE TABS 120MG FLUOCINOLONE ACETONIDE CREA 0.01% FOSINOPRIL SODIUM TABS 20MG GLYBURIDE MICRONIZED TABS 3MG FENOFIBRATE TABS 145MG FLUOCINOLONE ACETONIDE CREA 0.025% FOSINOPRIL SODIUM TABS 40MG GLYBURIDE MICRONIZED TABS 6MG FENOFIBRATE TABS 160MG FLUOCINOLONE ACETONIDE OIL 0.01% FOSINOPRIL SODIUM-HCTZ TABS 10-12.5MG GLYBURIDE TABS 1.25MG FENOFIBRATE TABS 40MG FLUOCINOLONE ACETONIDE OINT 0.025% FOSINOPRIL SODIUM-HCTZ TABS 20-12.5MG GLYBURIDE TABS 2.5MG FENOFIBRATE TABS 48MG FLUOCINOLONE ACETONIDE SCALP OIL 0.01% FOSPHENYTOIN SODIUM SOLN 100MG PE/2ML GLYBURIDE TABS 5MG FENOFIBRATE TABS 54MG FLUOCINOLONE ACETONIDE SOLN 0.01% FOSPHENYTOIN SODIUM SOLN 500MG PE/10ML GLYBURIDE-METFORMIN TABS 1.25-250MG FENOFIBRIC ACID CPDR 135MG FLUOCINONIDE CREA 0.05% FROVATRIPTAN SUCCINATE TABS 2.5MG GLYBURIDE-METFORMIN TABS 2.5-500MG FENOFIBRIC ACID CPDR 45MG FLUOCINONIDE CREA 0.1% FUROSEMIDE SOLN 10MG/ML GLYBURIDE-METFORMIN TABS 5-500MG FENOPROFEN CALCIUM TABS 600MG FLUOCINONIDE EMULSIFIED BASE CREA 0.05% FUROSEMIDE TABS 20MG GLYCOPYRROLATE SOLN 0.2MG/ML FENTANYL CITRATE (PF) SOLN 1000MCG/20ML FLUOCINONIDE GEL 0.05% FUROSEMIDE TABS 40MG GLYCOPYRROLATE SOLN 0.4MG/2ML FENTANYL CITRATE (PF) SOLN 100MCG/2ML FLUOCINONIDE OINT 0.05% FUROSEMIDE TABS 80MG GLYCOPYRROLATE SOLN 1MG/5ML FENTANYL CITRATE (PF) SOLN 2500MCG/50ML FLUOCINONIDE SOLN 0.05% FYAVOLV TABS 0.5-2.5MG-MCG GLYCOPYRROLATE SOLN 4MG/20ML FENTANYL CITRATE (PF) SOLN 250MCG/5ML FLUORITAB CHEW 1.1 (0.5 F)MG GLYCOPYRROLATE TABS 1MG FENTANYL CITRATE LPOP 1200MCG FLUORITAB CHEW 2.2 (1 F)MG G GLYCOPYRROLATE TABS 2MG FENTANYL CITRATE LPOP 1600MCG SUSP 0.1% GABAPENTIN CAPS 100MG GLYDO PRSY 2% FENTANYL CITRATE LPOP 200MCG FLUOROURACIL CREA 5% GABAPENTIN CAPS 300MG GRAFCO NIT APPLICATOR MISC 75-25% FENTANYL CITRATE LPOP 400MCG FLUOXETINE HCL (PMDD) TABS 10MG GABAPENTIN CAPS 400MG GRANISETRON HCL SOLN 1MG/ML FENTANYL CITRATE LPOP 600MCG FLUOXETINE HCL (PMDD) TABS 20MG GABAPENTIN SOLN 250MG/5ML GRANISETRON HCL SOLN 4MG/4ML FENTANYL CITRATE LPOP 800MCG FLUOXETINE HCL CAPS 10MG GABAPENTIN TABS 600MG GRANISETRON HCL TABS 1MG FENTANYL PT72 100MCG/HR FLUOXETINE HCL CAPS 20MG GABAPENTIN TABS 800MG GREEN GLO LISSAMINE GREEN STRP 1.5MG FENTANYL PT72 12MCG/HR FLUOXETINE HCL CAPS 40MG GALANTAMINE HYDROBROMIDE ER CP24 16MG GRISEOFULVIN MICROSIZE SUSP 125MG/5ML FENTANYL PT72 25MCG/HR FLUOXETINE HCL SOLN 20MG/5ML GALANTAMINE HYDROBROMIDE ER CP24 24MG GRISEOFULVIN MICROSIZE TABS 500MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. GRISEOFULVIN ULTRAMICROSIZE TABS 125MG HYDROCODONE-IBUPROFEN TABS 10-200MG HYOSCYAMINE SULFATE SOLN 0.125MG/ML ISOSORBIDE MONONITRATE TABS 10MG GRISEOFULVIN ULTRAMICROSIZE TABS 250MG HYDROCODONE-IBUPROFEN TABS 5-200MG HYOSCYAMINE SULFATE SUBL 0.125MG ISOSORBIDE MONONITRATE TABS 20MG HCL ER TB24 1MG HYDROCODONE-IBUPROFEN TABS 7.5-200MG HYOSCYAMINE SULFATE TABS 0.125MG ISOSULFAN BLUE SOLN 1% GUANFACINE HCL ER TB24 2MG ACE-PRAMOXINE CREA 1-1% HCL TABS 10MG GUANFACINE HCL ER TB24 3MG HYDROCORTISONE ACE-PRAMOXINE CREA 2.5-1% I ISOXSUPRINE HCL TABS 20MG GUANFACINE HCL ER TB24 4MG HYDROCORTISONE ACE-PRAMOXINE CREA 2.5-1% IBANDRONATE SODIUM TABS 150MG ISRADIPINE CAPS 2.5MG GUANFACINE HCL TABS 1MG HYDROCORTISONE ACETATE SUPP 25MG IBUPROFEN LYSINE SOLN 10MG/ML ISRADIPINE CAPS 5MG GUANFACINE HCL TABS 2MG HYDROCORTISONE ACETATE SUPP 30MG IBUPROFEN SUSP 100MG/5ML ITRACONAZOLE CAPS 100MG HYDROCORTISONE BUTYR LIPO BASE CREA 0.1% IBUPROFEN TABS 400MG ITRACONAZOLE SOLN 10MG/ML H HYDROCORTISONE BUTYRATE CREA 0.1% IBUPROFEN TABS 600MG IVERMECTIN TABS 3MG HALCINONIDE CREA 0.1% HYDROCORTISONE BUTYRATE LOTN 0.1% IBUPROFEN TABS 800MG HALOBETASOL PROPIONATE CREA 0.05% HYDROCORTISONE BUTYRATE OINT 0.1% IBUTILIDE FUMARATE SOLN 1MG/10ML J HALOBETASOL PROPIONATE OINT 0.05% HYDROCORTISONE BUTYRATE SOLN 0.1% IMATINIB MESYLATE TABS 100MG JINTELI TABS 1-5MG-MCG DECANOATE SOLN 100MG/ML HYDROCORTISONE CREA 1% IMATINIB MESYLATE TABS 400MG JUNEL FE 1.5/30 TABS 1.5-30MG-MCG SOLN 50MG/ML HYDROCORTISONE CREA 1% IMIPENEM-CILASTATIN SOLR 250MG JUNEL FE 24 TABS 1-20MG-MCG(24) HALOPERIDOL LACTATE CONC 2MG/ML HYDROCORTISONE CREA 2.5% IMIPENEM-CILASTATIN SOLR 500MG HALOPERIDOL LACTATE SOLN 5MG/ML HYDROCORTISONE LOTN 2.5% HCL TABS 10MG K HALOPERIDOL TABS 0.5MG HYDROCORTISONE OINT 1% IMIPRAMINE HCL TABS 25MG KCL IN DEXTROSE-NACL SOLN 10-5-0.45MEQ/L-%-% HALOPERIDOL TABS 10MG HYDROCORTISONE OINT 2.5% IMIPRAMINE HCL TABS 50MG KCL IN DEXTROSE-NACL SOLN 20-5-0.2MEQ/L-%-% HALOPERIDOL TABS 1MG HYDROCORTISONE TABS 10MG IMIPRAMINE PAMOATE CAPS 100MG KCL IN DEXTROSE-NACL SOLN 20-5-0.45MEQ/L-%-% HALOPERIDOL TABS 20MG HYDROCORTISONE TABS 20MG IMIPRAMINE PAMOATE CAPS 125MG KCL IN DEXTROSE-NACL SOLN 20-5-0.9MEQ/L-%-% HALOPERIDOL TABS 2MG HYDROCORTISONE TABS 5MG IMIPRAMINE PAMOATE CAPS 150MG KCL IN DEXTROSE-NACL SOLN 30-5-0.45MEQ/L-%-% HALOPERIDOL TABS 5MG HYDROCORTISONE VALERATE CREA 0.2% IMIPRAMINE PAMOATE CAPS 75MG KCL IN DEXTROSE-NACL SOLN 40-5-0.45MEQ/L-%-% HEPARIN (PORCINE) IN NACL SOLN 1000-0.9UT/500ML-% HYDROCORTISONE VALERATE OINT 0.2% IMIQUIMOD CREA 5% KELNOR 1/50 TABS 1-50MG-MCG HEPARIN (PORCINE) IN NACL SOLN 2000-0.9UNIT/L-% HYDROCORTISONE-ACETIC ACID SOLN 1-2% INDAPAMIDE TABS 1.25MG KETAMINE HCL SOLN 100MG/ML HEPARIN LOCK FLUSH SOLN 100UNIT/ML HYDROCORTISONE-IODOQUINOL CREA 1-1% INDAPAMIDE TABS 2.5MG KETAMINE HCL SOLN 10MG/ML HEPARIN LOCK FLUSH SOLN 10UNIT/ML HYDROMET SYRP 5-1.5MG/5ML INDOCYANINE GREEN SOLR 25MG KETAMINE HCL SOLN 50MG/ML HEPARIN SODIUM (PORCINE) PF SOLN 5000UNIT/0.5ML HYDROMORPHONE HCL ER T24A 12MG INDOMETHACIN CAPS 50MG CREA 2% HEPARIN SODIUM (PORCINE) SOLN 10000UNIT/ML HYDROMORPHONE HCL ER T24A 16MG INDOMETHACIN ER CPCR 75MG KETOCONAZOLE FOAM 2% HEPARIN SODIUM (PORCINE) SOLN 1000UNIT/ML HYDROMORPHONE HCL ER T24A 32MG INDOMETHACIN SODIUM SOLR 1MG KETOCONAZOLE SHAM 2% HEPARIN SODIUM (PORCINE) SOLN 20000UNIT/ML HYDROMORPHONE HCL ER T24A 8MG IODOQUINOL-HC-ALOE POLYSACCH GEL 1-2-1% KETOCONAZOLE TABS 200MG HEPARIN SODIUM (PORCINE) SOLN 5000UNIT/ML HYDROMORPHONE HCL LIQD 1MG/ML IODOQUINOL-HYDROCORTISONE-ALOE CREA 1-1.9% KETOROLAC TROMETHAMINE SOLN 0.4% HETASTARCH-NACL SOLN 6-0.9% HYDROMORPHONE HCL PF SOLN 10MG/ML IPRATROPIUM BROMIDE SOLN 0.02% KETOROLAC TROMETHAMINE SOLN 0.5% HIDEX 6-DAY TBPK 1.5MG (21) HYDROMORPHONE HCL PF SOLN 2MG/ML IPRATROPIUM BROMIDE SOLN 0.03% KETOROLAC TROMETHAMINE SOLN 15MG/ML HOMATROPINE HBR SOLN 5% HYDROMORPHONE HCL SOLN 1MG/ML IPRATROPIUM BROMIDE SOLN 0.06% KETOROLAC TROMETHAMINE SOLN 30MG/ML HYDRALAZINE HCL SOLN 20MG/ML HYDROMORPHONE HCL SOLN 2MG/ML IPRATROPIUM-ALBUTEROL SOLN 0.5-2.5 (3)MG/3ML KETOROLAC TROMETHAMINE SOLN 60MG/2ML HYDRALAZINE HCL TABS 100MG HYDROMORPHONE HCL TABS 2MG IRBESARTAN-HYDROCHLOROTHIAZIDE TABS 150-12.5MG KETOROLAC TROMETHAMINE TABS 10MG HYDRALAZINE HCL TABS 10MG HYDROMORPHONE HCL TABS 4MG IRBESARTAN-HYDROCHLOROTHIAZIDE TABS 300-12.5MG KETOTIFEN FUMARATE SOLN 0.025% HYDRALAZINE HCL TABS 25MG HYDROMORPHONE HCL TABS 8MG ISOFLURANE SOLN KLOR-CON 10 TBCR 10MEQ HYDRALAZINE HCL TABS 50MG CREA 4% ISONIAZID TABS 100MG KLOR-CON M10 TBCR 10MEQ HYDROCHLOROTHIAZIDE CAPS 12.5MG HYDROQUINONE TIME RELEASE CREA 4% ISONIAZID TABS 300MG KLOR-CON M20 TBCR 20MEQ HYDROCHLOROTHIAZIDE TABS 12.5MG HYDROXYCHLOROQUINE SULFATE TABS 200MG SOLN 99% KLOR-CON PACK 20MEQ HYDROCHLOROTHIAZIDE TABS 25MG HCL TABS 10MG ISOPROTERENOL HCL SOLN 0.2MG/ML KLOR-CON TBCR 8MEQ HYDROCHLOROTHIAZIDE TABS 50MG HYDROXYZINE HCL TABS 25MG ISOSORBIDE DINITRATE TABS 10MG KLOR-CON/EF TBEF 25MEQ HYDROCODONE-ACETAMINOPHEN SOLN 7.5-325MG/15ML HYDROXYZINE HCL TABS 50MG ISOSORBIDE DINITRATE TABS 20MG HYDROCODONE-ACETAMINOPHEN TABS 10-325MG HYDROXYZINE PAMOATE CAPS 25MG ISOSORBIDE DINITRATE TABS 5MG L HYDROCODONE-ACETAMINOPHEN TABS 5-325MG HYDROXYZINE PAMOATE CAPS 50MG ISOSORBIDE MONONITRATE ER TB24 120MG HCL SOLN 5MG/ML HYDROCODONE-ACETAMINOPHEN TABS 7.5-325MG HYOSCYAMINE SULFATE ELIX 0.125MG/5ML ISOSORBIDE MONONITRATE ER TB24 30MG LABETALOL HCL TABS 100MG HYDROCODONE-HOMATROPINE TABS 5-1.5MG HYOSCYAMINE SULFATE ER TB12 0.375MG ISOSORBIDE MONONITRATE ER TB24 60MG LABETALOL HCL TABS 200MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. LACTATED RINGERS SOLN LEVOCETIRIZINE DIHYDROCHLORIDE TABS 5MG LIDOCAINE-HYDROCORTISONE ACE KIT 3-0.5% LUDENT CHEW 0.55 (0.25 F)MG LACTATED RINGERS SOLN LEVOFLOXACIN IN D5W SOLN 250MG/50ML LIDOCAINE-HYDROCORTISONE ACE KIT 3-1% LACTULOSE ENCEPHALOPATHY SOLN 10GM/15ML LEVOFLOXACIN IN D5W SOLN 500MG/100ML LIDOCAINE-HYDROCORTISONE ACE KIT 3-2.5% M LACTULOSE SOLN 10GM/15ML LEVOFLOXACIN IN D5W SOLN 750MG/150ML LIDOCAINE-PRILOCAINE CREA 2.5-2.5% MAFENIDE ACETATE PACK 5% LAMOTRIGINE CHEW 25MG LEVOFLOXACIN SOLN 0.5% LIDOCAINE-PRILOCAINE KIT 2.5-2.5% SOLN 20GM/500ML LAMOTRIGINE CHEW 5MG LEVOFLOXACIN SOLN 25MG/ML LIDOZION LOTN 3% MAGNESIUM SULFATE SOLN 2GM/50ML LAMOTRIGINE ER TB24 100MG LEVOFLOXACIN SOLN 25MG/ML LINCOMYCIN HCL SOLN 300MG/ML MAGNESIUM SULFATE SOLN 40GM/1000ML LAMOTRIGINE ER TB24 200MG LEVOFLOXACIN TABS 250MG LINEZOLID SOLN 600MG/300ML MAGNESIUM SULFATE SOLN 4GM/100ML LAMOTRIGINE ER TB24 250MG LEVOFLOXACIN TABS 500MG LINEZOLID SUSR 100MG/5ML MAGNESIUM SULFATE SOLN 4GM/50ML LAMOTRIGINE ER TB24 25MG LEVOFLOXACIN TABS 750MG LINEZOLID TABS 600MG MAGNESIUM SULFATE SOLN 50% LAMOTRIGINE ER TB24 300MG LEVONORGEST-ETH ESTRAD 91-DAY TABS 0.15-0.03MG LIOTHYRONINE SODIUM SOLN 10MCG/ML MALATHION LOTN 0.5% LAMOTRIGINE ER TB24 50MG LEVONORGESTREL-ETHINYL ESTRAD TABS 0.15-30MG-MCG LIOTHYRONINE SODIUM TABS 25MCG MANNITOL SOLN 20% LAMOTRIGINE STARTER KIT-ORANGE KIT 42 X 25 MG &7 X 100 MG LEVORPHANOL TARTRATE TABS 2MG LIOTHYRONINE SODIUM TABS 50MCG MANNITOL SOLN 25% LAMOTRIGINE TABS 100MG LEVOTHYROXINE SODIUM SOLR 100MCG LIOTHYRONINE SODIUM TABS 5MCG MATZIM LA TB24 180MG LAMOTRIGINE TABS 150MG LEVOTHYROXINE SODIUM SOLR 200MCG LISINOPRIL TABS 10MG MATZIM LA TB24 240MG LAMOTRIGINE TABS 200MG LEVOTHYROXINE SODIUM SOLR 500MCG LISINOPRIL TABS 2.5MG MATZIM LA TB24 300MG LAMOTRIGINE TABS 25MG LEVOTHYROXINE SODIUM TABS 100MCG LISINOPRIL TABS 20MG MATZIM LA TB24 360MG LAMOTRIGINE TBDP 100MG LEVOTHYROXINE SODIUM TABS 112MCG LISINOPRIL TABS 30MG MATZIM LA TB24 420MG LAMOTRIGINE TBDP 200MG LEVOTHYROXINE SODIUM TABS 125MCG LISINOPRIL TABS 40MG MD-GASTROVIEW SOLN 66-10% LAMOTRIGINE TBDP 25MG LEVOTHYROXINE SODIUM TABS 137MCG LISINOPRIL TABS 5MG MECLIZINE HCL CHEW 25MG LAMOTRIGINE TBDP 50MG LEVOTHYROXINE SODIUM TABS 150MCG LISINOPRIL-HYDROCHLOROTHIAZIDE TABS 10-12.5MG MECLIZINE HCL TABS 12.5MG LANSOPRAZOLE CPDR 15MG LEVOTHYROXINE SODIUM TABS 175MCG LISINOPRIL-HYDROCHLOROTHIAZIDE TABS 20-12.5MG MECLIZINE HCL TABS 25MG LANSOPRAZOLE CPDR 30MG LEVOTHYROXINE SODIUM TABS 200MCG LISINOPRIL-HYDROCHLOROTHIAZIDE TABS 20-25MG ACETATE TABS 10MG LANSOPRAZOLE TBDD 15MG LEVOTHYROXINE SODIUM TABS 300MCG CARBONATE CAPS 150MG MEDROXYPROGESTERONE ACETATE TABS 2.5MG LANSOPRAZOLE TBDD 30MG LEVOTHYROXINE SODIUM TABS 50MCG LITHIUM CARBONATE CAPS 300MG MEDROXYPROGESTERONE ACETATE TABS 5MG LANTHANUM CARBONATE CHEW 1000MG LEVOTHYROXINE SODIUM TABS 75MCG LITHIUM CARBONATE CAPS 600MG MEFENAMIC ACID CAPS 250MG LANTHANUM CARBONATE CHEW 500MG LEVOTHYROXINE SODIUM TABS 88MCG LITHIUM CARBONATE ER TBCR 300MG ACETATE SUSP 40MG/ML LANTHANUM CARBONATE CHEW 750MG LIDOCAINE HCL (CARDIAC) SOSY 100MG/5ML LITHIUM CARBONATE ER TBCR 450MG SUSP 625MG/5ML LATANOPROST SOLN 0.005% LIDOCAINE HCL (PF) SOLN 0.5% LITHIUM CARBONATE TABS 300MG MELOXICAM TABS 15MG LEFLUNOMIDE TABS 10MG LIDOCAINE HCL (PF) SOLN 1.5% LOPERAMIDE HCL CAPS 2MG MELOXICAM TABS 7.5MG LEFLUNOMIDE TABS 20MG LIDOCAINE HCL (PF) SOLN 1% LORAZEPAM INTENSOL CONC 2MG/ML MELPHALAN HCL SOLR 50MG LEVALBUTEROL HCL NEBU 0.31MG/3ML LIDOCAINE HCL (PF) SOLN 2% LORAZEPAM SOLN 2MG/ML MEMANTINE HCL ER CP24 14MG LEVALBUTEROL HCL NEBU 0.63MG/3ML LIDOCAINE HCL CREA 3% LORAZEPAM SOLN 4MG/ML MEMANTINE HCL ER CP24 21MG LEVALBUTEROL HCL NEBU 1.25MG/0.5ML LIDOCAINE HCL SOLN 0.5% LORAZEPAM TABS 0.5MG MEMANTINE HCL ER CP24 28MG LEVALBUTEROL HCL NEBU 1.25MG/3ML LIDOCAINE HCL SOLN 1% LORAZEPAM TABS 1MG MEMANTINE HCL ER CP24 7MG LEVETIRACETAM ER TB24 500MG LIDOCAINE HCL SOLN 2% LORAZEPAM TABS 2MG MEMANTINE HCL SOLN 10MG/5ML LEVETIRACETAM ER TB24 750MG LIDOCAINE HCL SOLN 4% LOSARTAN POTASSIUM TABS 100MG MEMANTINE HCL TABS 10MG LEVETIRACETAM IN NACL SOLN 1000MG/100ML LIDOCAINE HCL URETHRAL/MUCOSAL GEL 2% LOSARTAN POTASSIUM TABS 25MG MEMANTINE HCL TABS 5MG LEVETIRACETAM IN NACL SOLN 1500MG/100ML LIDOCAINE IN D5W SOLN 4-5MG/ML-% LOSARTAN POTASSIUM TABS 50MG MEROPENEM SOLR 1GM LEVETIRACETAM IN NACL SOLN 500MG/100ML LIDOCAINE IN D5W SOLN 8-5MG/ML-% LOSARTAN POTASSIUM-HCTZ TABS 100-12.5MG MEROPENEM SOLR 500MG LEVETIRACETAM SOLN 100MG/ML LIDOCAINE OINT 5% LOSARTAN POTASSIUM-HCTZ TABS 100-25MG MESALAMINE CPDR 400MG LEVETIRACETAM SOLN 500MG/5ML LIDOCAINE PTCH 5% LOSARTAN POTASSIUM-HCTZ TABS 50-12.5MG MESALAMINE ENEM 4GM LEVETIRACETAM TABS 1000MG LIDOCAINE VISCOUS HCL SOLN 2% LOTEPREDNOL ETABONATE SUSP 0.5% MESALAMINE SUPP 1000MG LEVETIRACETAM TABS 250MG LIDOCAINE-EPINEPHRINE SOLN 0.5%-1:200000 LOVASTATIN TABS 10MG MESALAMINE TBEC 1.2GM LEVETIRACETAM TABS 500MG LIDOCAINE-EPINEPHRINE SOLN 1.5%-1:200000 LOVASTATIN TABS 20MG MESALAMINE TBEC 800MG LEVETIRACETAM TABS 750MG LIDOCAINE-EPINEPHRINE SOLN 1%-1:100000 LOVASTATIN TABS 40MG MESALAMINE-CLEANSER KIT 4GM HCL SOLN 0.5% LIDOCAINE-EPINEPHRINE SOLN 2%-1:100000 SUCCINATE CAPS 10MG MESNA SOLN 100MG/ML LEVOCARNITINE SOLN 1GM/10ML LIDOCAINE-EPINEPHRINE SOLN 2%-1:200000 LOXAPINE SUCCINATE CAPS 25MG METAXALONE TABS 800MG LEVOCARNITINE TABS 330MG LIDOCAINE-HYDROCORTISONE ACE CREA 3-0.5% LOXAPINE SUCCINATE CAPS 50MG METFORMIN HCL ER (MOD) TB24 1000MG LEVOCETIRIZINE DIHYDROCHLORIDE SOLN 2.5MG/5ML LIDOCAINE-HYDROCORTISONE ACE KIT 2-2% LOXAPINE SUCCINATE CAPS 5MG METFORMIN HCL ER (MOD) TB24 500MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. METFORMIN HCL ER (OSM) TB24 1000MG HCL SOLN 10MG/5ML MIDAZOLAM HCL SYRP 2MG/ML MONTELUKAST SODIUM CHEW 5MG METFORMIN HCL ER (OSM) TB24 500MG METHYLPHENIDATE HCL SOLN 5MG/5ML HCL TABS 10MG MONTELUKAST SODIUM PACK 4MG METFORMIN HCL ER TB24 500MG METHYLPHENIDATE HCL TABS 10MG MIDODRINE HCL TABS 2.5MG MONTELUKAST SODIUM TABS 10MG METFORMIN HCL ER TB24 750MG METHYLPHENIDATE HCL TABS 20MG MIDODRINE HCL TABS 5MG MORPHINE SULFATE (PF) SOLN 0.5MG/ML METFORMIN HCL TABS 1000MG METHYLPHENIDATE HCL TABS 5MG TABS 200MG MORPHINE SULFATE (PF) SOLN 10MG/ML METFORMIN HCL TABS 500MG METHYLPREDNISOLONE ACETATE SUSP 40MG/ML MIGLITOL TABS 100MG MORPHINE SULFATE (PF) SOLN 1MG/ML METFORMIN HCL TABS 850MG METHYLPREDNISOLONE ACETATE SUSP 80MG/ML MIGLITOL TABS 25MG MORPHINE SULFATE ER CP24 100MG METHADONE HCL CONC 10MG/ML METHYLPREDNISOLONE SODIUM SUCC SOLR 1000MG MIGLITOL TABS 50MG MORPHINE SULFATE ER CP24 10MG METHADONE HCL SOLN 10MG/5ML METHYLPREDNISOLONE SODIUM SUCC SOLR 125MG MILRINONE LACTATE IN DEXTROSE SOLN 20-5MG/100ML-% MORPHINE SULFATE ER CP24 20MG METHADONE HCL SOLN 10MG/ML METHYLPREDNISOLONE SODIUM SUCC SOLR 40MG MILRINONE LACTATE IN DEXTROSE SOLN 40-5MG/200ML-% MORPHINE SULFATE ER CP24 30MG METHADONE HCL SOLN 5MG/5ML METHYLPREDNISOLONE TABS 16MG MILRINONE LACTATE SOLN 10MG/10ML MORPHINE SULFATE ER CP24 40MG METHADONE HCL TABS 10MG METHYLPREDNISOLONE TABS 32MG MILRINONE LACTATE SOLN 20MG/20ML MORPHINE SULFATE ER CP24 50MG METHADONE HCL TABS 5MG METHYLPREDNISOLONE TABS 4MG MILRINONE LACTATE SOLN 50MG/50ML MORPHINE SULFATE ER CP24 60MG METHADONE HCL TBSO 40MG METHYLPREDNISOLONE TABS 8MG MIMVEY LO TABS 0.5-0.1MG MORPHINE SULFATE ER CP24 80MG HCL TABS 5MG METHYLPREDNISOLONE TBPK 4MG MIMVEY TABS 1-0.5MG MORPHINE SULFATE ER TBCR 100MG METHAZOLAMIDE TABS 25MG METOCLOPRAMIDE HCL SOLN 5MG/5ML MINOCYCLINE HCL CAPS 100MG MORPHINE SULFATE ER TBCR 15MG METHAZOLAMIDE TABS 50MG METOCLOPRAMIDE HCL SOLN 5MG/ML MINOCYCLINE HCL CAPS 50MG MORPHINE SULFATE ER TBCR 200MG METHENAMINE HIPPURATE TABS 1GM METOCLOPRAMIDE HCL TABS 10MG MINOCYCLINE HCL CAPS 75MG MORPHINE SULFATE ER TBCR 30MG METHENAMINE MANDELATE TABS 0.5GM METOCLOPRAMIDE HCL TABS 5MG MINOCYCLINE HCL ER TB24 105MG MORPHINE SULFATE ER TBCR 60MG METHENAMINE MANDELATE TABS 1GM METOLAZONE TABS 10MG MINOCYCLINE HCL ER TB24 115MG MORPHINE SULFATE SOLN 10MG/5ML METHIMAZOLE TABS 10MG METOLAZONE TABS 2.5MG MINOCYCLINE HCL ER TB24 135MG MORPHINE SULFATE SOLN 1MG/ML METHIMAZOLE TABS 5MG METOLAZONE TABS 5MG MINOCYCLINE HCL ER TB24 45MG MORPHINE SULFATE SOLN 20MG/5ML METHOCARBAMOL SOLN 1000MG/10ML SUCCINATE ER TB24 100MG MINOCYCLINE HCL ER TB24 55MG MORPHINE SULFATE TABS 15MG METHOCARBAMOL TABS 500MG METOPROLOL SUCCINATE ER TB24 200MG MINOCYCLINE HCL ER TB24 65MG MORPHINE SULFATE TABS 30MG METHOCARBAMOL TABS 750MG METOPROLOL SUCCINATE ER TB24 25MG MINOCYCLINE HCL ER TB24 80MG MOXIFLOXACIN HCL IN NACL SOLN 400MG/250ML METHOXSALEN RAPID CAPS 10MG METOPROLOL SUCCINATE ER TB24 50MG MINOCYCLINE HCL ER TB24 90MG MOXIFLOXACIN HCL SOLN 0.5% TABS 250MG METOPROLOL TARTRATE SOLN 5MG/5ML MINOCYCLINE HCL TABS 100MG MOXIFLOXACIN HCL TABS 400MG METHYLDOPA TABS 500MG METOPROLOL TARTRATE TABS 100MG MINOCYCLINE HCL TABS 50MG MULTIVITAMIN/FLUORIDE SOLN 0.25MG/ML METHYLERGONOVINE MALEATE SOLN 0.2MG/ML METOPROLOL TARTRATE TABS 25MG MINOCYCLINE HCL TABS 75MG MULTIVITAMIN/FLUORIDE SOLN 0.5MG/ML METHYLERGONOVINE MALEATE TABS 0.2MG METOPROLOL TARTRATE TABS 50MG TABS 10MG MULTIVITAMIN/FLUORIDE/IRON SOLN 0.25-10MG/ML METHYLPHENIDATE HCL CHEW 10MG METOPROLOL-HYDROCHLOROTHIAZIDE TABS 100-25MG MINOXIDIL TABS 2.5MG OINT 2% METHYLPHENIDATE HCL CHEW 2.5MG METOPROLOL-HYDROCHLOROTHIAZIDE TABS 50-25MG TABS 15MG MVC-FLUORIDE CHEW 0.25MG METHYLPHENIDATE HCL CHEW 5MG METRONIDAZOLE CAPS 375MG MIRTAZAPINE TABS 30MG MVC-FLUORIDE CHEW 0.5MG METHYLPHENIDATE HCL ER (CD) CPCR 10MG METRONIDAZOLE CREA 0.75% MIRTAZAPINE TABS 45MG MVC-FLUORIDE CHEW 1MG METHYLPHENIDATE HCL ER (CD) CPCR 20MG METRONIDAZOLE GEL 0.75% MIRTAZAPINE TABS 7.5MG MYCOPHENOLATE SODIUM TBEC 180MG METHYLPHENIDATE HCL ER (CD) CPCR 30MG METRONIDAZOLE GEL 1% MIRTAZAPINE TBDP 15MG MYCOPHENOLATE SODIUM TBEC 360MG METHYLPHENIDATE HCL ER (CD) CPCR 40MG METRONIDAZOLE IN NACL SOLN 5-0.79MG/ML-% MIRTAZAPINE TBDP 30MG MYFERON 150 FORTE CAPS 150-25-1MG-MCG-MG METHYLPHENIDATE HCL ER (CD) CPCR 50MG METRONIDAZOLE LOTN 0.75% MIRTAZAPINE TBDP 45MG METHYLPHENIDATE HCL ER (CD) CPCR 60MG METRONIDAZOLE TABS 250MG MISOPROSTOL TABS 100MCG N METHYLPHENIDATE HCL ER (LA) CP24 10MG METRONIDAZOLE TABS 500MG MISOPROSTOL TABS 200MCG NA FERRIC GLUC CPLX IN SUCROSE SOLN 12.5MG/ML METHYLPHENIDATE HCL ER (LA) CP24 20MG MIDAZOLAM HCL (PF) SOLN 2MG/2ML MODAFINIL TABS 100MG NABUMETONE TABS 500MG METHYLPHENIDATE HCL ER (LA) CP24 30MG MIDAZOLAM HCL (PF) SOLN 5MG/ML MODAFINIL TABS 200MG NABUMETONE TABS 750MG METHYLPHENIDATE HCL ER (LA) CP24 40MG MIDAZOLAM HCL SOLN 10MG/10ML MOEXIPRIL HCL TABS 15MG TABS 20MG METHYLPHENIDATE HCL ER (LA) CP24 60MG MIDAZOLAM HCL SOLN 10MG/2ML MOEXIPRIL HCL TABS 7.5MG NADOLOL TABS 40MG METHYLPHENIDATE HCL ER TBCR 10MG MIDAZOLAM HCL SOLN 25MG/5ML FUROATE CREA 0.1% NADOLOL TABS 80MG METHYLPHENIDATE HCL ER TBCR 18MG MIDAZOLAM HCL SOLN 2MG/2ML MOMETASONE FUROATE OINT 0.1% NAFCILLIN SODIUM SOLR 10GM METHYLPHENIDATE HCL ER TBCR 20MG MIDAZOLAM HCL SOLN 50MG/10ML MOMETASONE FUROATE SOLN 0.1% NAFCILLIN SODIUM SOLR 1GM METHYLPHENIDATE HCL ER TBCR 27MG MIDAZOLAM HCL SOLN 5MG/5ML MOMETASONE FUROATE SUSP 50MCG/ACT NAFCILLIN SODIUM SOLR 2GM METHYLPHENIDATE HCL ER TBCR 36MG MIDAZOLAM HCL SOLN 5MG/ML MONTELUKAST SODIUM CHEW 4MG NAFTIFINE HCL CREA 1% METHYLPHENIDATE HCL ER TBCR 54MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. NAFTIFINE HCL CREA 2% NITROFURANTOIN MONOHYD MACRO CAPS 100MG TABS 10MG OSELTAMIVIR PHOSPHATE CAPS 45MG NALBUPHINE HCL SOLN 10MG/ML NITROFURANTOIN SUSP 25MG/5ML OLANZAPINE TABS 15MG OSELTAMIVIR PHOSPHATE CAPS 75MG NALBUPHINE HCL SOLN 20MG/ML NITROGLYCERIN ER CPCR 2.5MG OLANZAPINE TABS 20MG OSELTAMIVIR PHOSPHATE SUSR 6MG/ML NALOXONE HCL SOLN 0.4MG/ML NITROGLYCERIN PT24 0.1MG/HR OLANZAPINE TABS 5MG OXACILLIN SODIUM SOLR 10GM NALOXONE HCL SOLN 4MG/10ML NITROGLYCERIN PT24 0.2MG/HR OLANZAPINE TABS 7.5MG OXACILLIN SODIUM SOLR 1GM NALTREXONE HCL TABS 50MG NITROGLYCERIN PT24 0.4MG/HR OLANZAPINE TBDP 10MG OXACILLIN SODIUM SOLR 2GM NAPROXEN DR TBEC 375MG NITROGLYCERIN PT24 0.6MG/HR OLANZAPINE TBDP 15MG TABS 10MG NAPROXEN DR TBEC 500MG NITROGLYCERIN SOLN 0.4MG/SPRAY OLANZAPINE TBDP 20MG OXANDROLONE TABS 2.5MG NAPROXEN SODIUM ER TB24 375MG NITROGLYCERIN SUBL 0.3MG OLANZAPINE TBDP 5MG OXAPROZIN TABS 600MG NAPROXEN SODIUM ER TB24 500MG NITROGLYCERIN SUBL 0.4MG OLANZAPINE-FLUOXETINE HCL CAPS 12-25MG OXCARBAZEPINE SUSP 300MG/5ML NAPROXEN SODIUM TABS 275MG NITROGLYCERIN SUBL 0.6MG OLANZAPINE-FLUOXETINE HCL CAPS 12-50MG OXCARBAZEPINE TABS 150MG NAPROXEN SODIUM TABS 550MG NITROPRUSSIDE SODIUM SOLN 25MG/ML OLANZAPINE-FLUOXETINE HCL CAPS 3-25MG OXCARBAZEPINE TABS 300MG NAPROXEN SUSP 125MG/5ML NIZATIDINE CAPS 150MG OLANZAPINE-FLUOXETINE HCL CAPS 6-25MG OXCARBAZEPINE TABS 600MG NAPROXEN TABS 250MG NIZATIDINE CAPS 300MG OLANZAPINE-FLUOXETINE HCL CAPS 6-50MG OXICONAZOLE NITRATE CREA 1% NAPROXEN TABS 375MG BITARTRATE SOLN 1MG/ML OLMESARTAN MEDOXOMIL TABS 20MG OXYBUTYNIN CHLORIDE ER TB24 10MG NAPROXEN TABS 500MG NORETHIN ACE-ETH ESTRAD-FE CHEW 1-20MG-MCG(24) OLMESARTAN MEDOXOMIL TABS 40MG OXYBUTYNIN CHLORIDE ER TB24 15MG NARATRIPTAN HCL TABS 1MG NORETHIN ACE-ETH ESTRAD-FE TABS 1-20MG-MCG OLMESARTAN MEDOXOMIL TABS 5MG OXYBUTYNIN CHLORIDE ER TB24 5MG NARATRIPTAN HCL TABS 2.5MG NORETHIN-ETH ESTRADIOL-FE CHEW 0.4-35MG-MCG OLMESARTAN MEDOXOMIL-HCTZ TABS 20-12.5MG OXYBUTYNIN CHLORIDE SYRP 5MG/5ML NATEGLINIDE TABS 120MG NORETHIN-ETH ESTRADIOL-FE CHEW 0.8-25MG-MCG OLMESARTAN MEDOXOMIL-HCTZ TABS 40-12.5MG OXYBUTYNIN CHLORIDE TABS 5MG NATEGLINIDE TABS 60MG NORETHINDRONE ACET-ETHINYL EST TABS 1-20MG-MCG OLMESARTAN MEDOXOMIL-HCTZ TABS 40-25MG OXYCODONE HCL CAPS 5MG NEO-POLYCIN HC OINT 1% NORETHINDRONE ACET-ETHINYL EST TABS 1.5-30MG-MCG OLMESARTAN-AMLODIPINE-HCTZ TABS 20-5-12.5MG OXYCODONE HCL CONC 100MG/5ML NEO-POLYCIN OINT 3.5-400-10000 NORETHINDRONE ACETATE TABS 5MG OLMESARTAN-AMLODIPINE-HCTZ TABS 40-10-12.5MG OXYCODONE HCL SOLN 5MG/5ML SULFATE TABS 500MG NORETHINDRONE TABS 0.35MG OLMESARTAN-AMLODIPINE-HCTZ TABS 40-10-25MG OXYCODONE HCL TABS 10MG NEOMYCIN-POLYMYXIN-DEXAMETH OINT 3.5-10000-0.1 NORTREL 0.5/35 (28) TABS 0.5-35MG-MCG OLMESARTAN-AMLODIPINE-HCTZ TABS 40-5-12.5MG OXYCODONE HCL TABS 15MG NEOMYCIN-POLYMYXIN-DEXAMETH SUSP 3.5-10000-0.1 NORTREL 1/35 (21) TABS 1-35MG-MCG OLMESARTAN-AMLODIPINE-HCTZ TABS 40-5-25MG OXYCODONE HCL TABS 20MG NEOMYCIN-POLYMYXIN-HC SOLN 1% NORTREL 7/7/7 TABS 0.5/0.75/1-35MG-MCG OLOPATADINE HCL SOLN 0.1% OXYCODONE HCL TABS 30MG NEOMYCIN-POLYMYXIN-HC SUSP 3.5-10000-1 HCL CAPS 10MG OLOPATADINE HCL SOLN 0.2% OXYCODONE HCL TABS 5MG NEOSTIGMINE METHYLSULFATE SOLN 10MG/10ML NORTRIPTYLINE HCL CAPS 25MG OLOPATADINE HCL SOLN 0.6% OXYCODONE-ACETAMINOPHEN TABS 10-325MG NEOSTIGMINE METHYLSULFATE SOLN 5MG/10ML NORTRIPTYLINE HCL CAPS 50MG OMEGA-3-ACID ETHYL ESTERS CAPS 1GM OXYCODONE-ACETAMINOPHEN TABS 2.5-325MG NEVIRAPINE ER TB24 100MG NORTRIPTYLINE HCL CAPS 75MG OMEPRAZOLE CPDR 10MG OXYCODONE-ACETAMINOPHEN TABS 5-325MG ER (ANTIHYPERLIPIDEMIC) TBCR 1000MG NP THYROID TABS 120MG OMEPRAZOLE CPDR 20MG OXYCODONE-ACETAMINOPHEN TABS 7.5-325MG NIACIN ER (ANTIHYPERLIPIDEMIC) TBCR 500MG NP THYROID TABS 15MG OMEPRAZOLE CPDR 40MG OXYMORPHONE HCL TABS 10MG NIACIN ER (ANTIHYPERLIPIDEMIC) TBCR 750MG NP THYROID TABS 30MG OMEPRAZOLE-SODIUM BICARBONATE CAPS 20-1100MG OXYMORPHONE HCL TABS 5MG NICARDIPINE HCL CAPS 20MG NP THYROID TABS 60MG OMEPRAZOLE-SODIUM BICARBONATE CAPS 40-1100MG OXYTOCIN SOLN 10UNIT/ML NICARDIPINE HCL CAPS 30MG NP THYROID TABS 90MG OMEPRAZOLE-SODIUM BICARBONATE PACK 20-1680MG NICARDIPINE HCL SOLN 2.5MG/ML NYSTATIN CREA 100000UNIT/GM OMEPRAZOLE-SODIUM BICARBONATE PACK 40-1680MG P NIFEDIPINE ER OSMOTIC RELEASE TB24 30MG NYSTATIN OINT 100000UNIT/GM ONDANSETRON HCL SOLN 40MG/20ML PACERONE TABS 100MG NIFEDIPINE ER OSMOTIC RELEASE TB24 60MG NYSTATIN SUSP 100000UNIT/ML ONDANSETRON HCL SOLN 4MG/2ML PACERONE TABS 400MG NIFEDIPINE ER OSMOTIC RELEASE TB24 90MG NYSTATIN TABS 500000UNIT ONDANSETRON HCL SOLN 4MG/5ML ER TB24 1.5MG NIFEDIPINE ER TB24 30MG NYSTATIN-TRIAMCINOLONE CREA 100000-0.1UNIT/GM-% ONDANSETRON HCL TABS 24MG PALIPERIDONE ER TB24 3MG NIFEDIPINE ER TB24 60MG NYSTATIN-TRIAMCINOLONE OINT 100000-0.1UNIT/GM-% ONDANSETRON HCL TABS 4MG PALIPERIDONE ER TB24 6MG NIFEDIPINE ER TB24 90MG NYSTOP POWD 100000UNIT/GM ONDANSETRON HCL TABS 8MG PALIPERIDONE ER TB24 9MG NIMODIPINE CAPS 30MG ONDANSETRON TBDP 4MG PALONOSETRON HCL SOLN 0.25MG/5ML NISOLDIPINE ER TB24 17MG O ONDANSETRON TBDP 8MG PALONOSETRON HCL SOSY 0.25MG/5ML NISOLDIPINE ER TB24 34MG OCUCOAT VISCOADHERENT SOLN 2% OPIUM TINC 10 MG/ML(1%) PANTOPRAZOLE SODIUM SOLR 40MG NISOLDIPINE ER TB24 8.5MG OFLOXACIN SOLN 0.3% ORPHENADRINE CITRATE ER TB12 100MG PANTOPRAZOLE SODIUM TBEC 20MG NITROFURANTOIN MACROCRYSTAL CAPS 100MG OFLOXACIN SOLN 0.3% ORPHENADRINE CITRATE SOLN 30MG/ML PANTOPRAZOLE SODIUM TBEC 40MG NITROFURANTOIN MACROCRYSTAL CAPS 25MG OFLOXACIN TABS 400MG ORSYTHIA TABS 0.1-20MG-MCG PARICALCITOL CAPS 1MCG NITROFURANTOIN MACROCRYSTAL CAPS 50MG OLANZAPINE SOLR 10MG OSELTAMIVIR PHOSPHATE CAPS 30MG PARICALCITOL CAPS 2MCG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. PARICALCITOL CAPS 4MCG HCL SOLN 10% POTASSIUM CHLORIDE IN DEXTROSE SOLN 20-5MEQ/L-% PREDNISONE TBPK 10MG (48) PARICALCITOL SOLN 2MCG/ML PHENYLEPHRINE HCL SOLN 10MG/ML POTASSIUM CHLORIDE IN NACL SOLN 20-0.45MEQ/L-% PREDNISONE TBPK 5MG (21) PARICALCITOL SOLN 5MCG/ML PHENYLEPHRINE HCL SOLN 2.5% POTASSIUM CHLORIDE IN NACL SOLN 20-0.9MEQ/L-% PREDNISONE TBPK 5MG (48) PAROMOMYCIN SULFATE CAPS 250MG CHEW 50MG POTASSIUM CHLORIDE IN NACL SOLN 40-0.9MEQ/L-% PREGABALIN CAPS 100MG PAROXETINE HCL ER TB24 12.5MG PHENYTOIN SODIUM EXTENDED CAPS 100MG POTASSIUM CHLORIDE SOLN 20 MEQ/15ML(10%) PREGABALIN CAPS 150MG PAROXETINE HCL ER TB24 25MG PHENYTOIN SODIUM EXTENDED CAPS 200MG POTASSIUM CHLORIDE SOLN 2MEQ/ML PREGABALIN CAPS 200MG PAROXETINE HCL ER TB24 37.5MG PHENYTOIN SODIUM EXTENDED CAPS 300MG POTASSIUM CHLORIDE SOLN 40 MEQ/15ML(20%) PREGABALIN CAPS 225MG PAROXETINE HCL TABS 10MG PHENYTOIN SODIUM SOLN 50MG/ML POTASSIUM CITRATE ER TBCR 10 MEQ(1080 MG) PREGABALIN CAPS 25MG PAROXETINE HCL TABS 20MG PHENYTOIN SUSP 125MG/5ML POTASSIUM CITRATE ER TBCR 15 MEQ(1620 MG) PREGABALIN CAPS 300MG PAROXETINE HCL TABS 30MG PHOSPHASAL TABS 81.6MG POTASSIUM CITRATE ER TBCR 5 MEQ(540 MG) PREGABALIN CAPS 50MG PAROXETINE HCL TABS 40MG PHOSPHO-TRIN 250 NEUTRAL TABS 155-852-130MG POTASSIUM CITRATE-CITRIC ACID SOLN 1100-334MG/5ML PREGABALIN CAPS 75MG PAROXETINE MESYLATE CAPS 7.5MG PHYTONADIONE TABS 5MG POTASSIUM PHOSPHATES SOLN 45MMOLE/15ML PREGABALIN SOLN 20MG/ML PEG 3350-KCL-NA BICARB-NACL SOLR 420GM PILOCARPINE HCL SOLN 1% PR BENZOYL PEROXIDE WASH LIQD 7% PREVIFEM TABS 0.25-35MG-MCG PEG-3350/ELECTROLYTES SOLR 236GM PILOCARPINE HCL SOLN 2% PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 0.375MG PRIMAQUINE PHOSPHATE TABS 26.3MG PENICILLIN G POTASSIUM SOLR 20000000UNIT PILOCARPINE HCL SOLN 4% PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 0.75MG PRIMIDONE TABS 250MG PENICILLIN G POTASSIUM SOLR 5000000UNIT PILOCARPINE HCL TABS 5MG PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 1.5MG PRIMIDONE TABS 50MG PENICILLIN V POTASSIUM TABS 250MG PILOCARPINE HCL TABS 7.5MG PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 2.25MG PROBENECID TABS 500MG PENICILLIN V POTASSIUM TABS 500MG CREA 1% PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 3.75MG PROCAINAMIDE HCL SOLN 100MG/ML PENTOBARBITAL SODIUM SOLN 50MG/ML TABS 10MG PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 3MG PROCAINAMIDE HCL SOLN 500MG/ML ER TBCR 400MG PINDOLOL TABS 5MG PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 4.5MG EDISYLATE SOLN 10MG/2ML PERINDOPRIL ERBUMINE TABS 2MG PIOGLITAZONE HCL TABS 15MG PRAMIPEXOLE DIHYDROCHLORIDE TABS 0.125MG PROCHLORPERAZINE MALEATE TABS 10MG PERINDOPRIL ERBUMINE TABS 4MG PIOGLITAZONE HCL TABS 30MG PRAMIPEXOLE DIHYDROCHLORIDE TABS 0.25MG PROCHLORPERAZINE MALEATE TABS 5MG PERINDOPRIL ERBUMINE TABS 8MG PIOGLITAZONE HCL TABS 45MG PRAMIPEXOLE DIHYDROCHLORIDE TABS 0.5MG PROCTOSOL HC CREA 2.5% PERMETHRIN CREA 5% PIOGLITAZONE HCL-GLIMEPIRIDE TABS 30-2MG PRAMIPEXOLE DIHYDROCHLORIDE TABS 0.75MG MICRONIZED CAPS 100MG TABS 16MG PIOGLITAZONE HCL-GLIMEPIRIDE TABS 30-4MG PRAMIPEXOLE DIHYDROCHLORIDE TABS 1.5MG PROGESTERONE MICRONIZED CAPS 200MG PERPHENAZINE TABS 2MG PIOGLITAZONE HCL-METFORMIN HCL TABS 15-500MG PRAMIPEXOLE DIHYDROCHLORIDE TABS 1MG HCL SOLN 25MG/ML PERPHENAZINE TABS 4MG PIOGLITAZONE HCL-METFORMIN HCL TABS 15-850MG PRASUGREL HCL TABS 10MG PROMETHAZINE HCL SOLN 50MG/ML PERPHENAZINE TABS 8MG PIPERACILLIN SOD-TAZOBACTAM SO SOLR 13.5 (12-1.5)GM PRASUGREL HCL TABS 5MG PROMETHAZINE HCL SYRP 6.25MG/5ML PHENADOZ SUPP 12.5MG PIPERACILLIN SOD-TAZOBACTAM SO SOLR 2.25 (2-0.25)GM PRAVASTATIN SODIUM TABS 10MG PROMETHAZINE HCL TABS 12.5MG PHENADOZ SUPP 25MG PIPERACILLIN SOD-TAZOBACTAM SO SOLR 3.375 (3-0.375)GM PRAVASTATIN SODIUM TABS 20MG PROMETHAZINE HCL TABS 25MG PHENAZOPYRIDINE HCL TABS 100MG PIPERACILLIN SOD-TAZOBACTAM SO SOLR 4.5 (4-0.5)GM PRAVASTATIN SODIUM TABS 40MG PROMETHAZINE HCL TABS 50MG PHENAZOPYRIDINE HCL TABS 200MG PIPERACILLIN SOD-TAZOBACTAM SO SOLR 40.5 (36-4.5)GM PRAVASTATIN SODIUM TABS 80MG PROMETHAZINE-CODEINE SYRP 6.25-10MG/5ML PHENDIMETRAZINE TARTRATE TABS 35MG PIROXICAM CAPS 10MG PRAZIQUANTEL TABS 600MG PROMETHEGAN SUPP 50MG PHENELZINE SULFATE TABS 15MG PIROXICAM CAPS 20MG HCL CAPS 1MG HCL ER CP12 225MG PHENOBARBITAL ELIX 20MG/5ML PLASBUMIN-25 SOLN 25% PRAZOSIN HCL CAPS 2MG PROPAFENONE HCL ER CP12 325MG PHENOBARBITAL TABS 100MG PLASBUMIN-5 SOLN 5% PRAZOSIN HCL CAPS 5MG PROPAFENONE HCL ER CP12 425MG PHENOBARBITAL TABS 15MG PLENAMINE SOLN 15% PREDNISOLONE SODIUM PHOSPHATE SOLN 10MG/5ML PROPAFENONE HCL TABS 150MG PHENOBARBITAL TABS 16.2MG PODOFILOX SOLN 0.5% PREDNISOLONE SODIUM PHOSPHATE SOLN 15MG/5ML PROPAFENONE HCL TABS 225MG PHENOBARBITAL TABS 30MG POLOCAINE SOLN 1% PREDNISOLONE SODIUM PHOSPHATE SOLN 20MG/5ML PROPAFENONE HCL TABS 300MG PHENOBARBITAL TABS 32.4MG POLOCAINE-MPF SOLN 1.5% PREDNISOLONE SODIUM PHOSPHATE SOLN 6.7 (5 BASE)MG/5ML PROPARACAINE HCL SOLN 0.5% PHENOBARBITAL TABS 60MG POLOCAINE-MPF SOLN 1% PREDNISOLONE SODIUM PHOSPHATE TBDP 10MG PROPOFOL EMUL 1000MG/100ML PHENOBARBITAL TABS 64.8MG POLOCAINE-MPF SOLN 2% PREDNISOLONE SODIUM PHOSPHATE TBDP 15MG PROPOFOL EMUL 200MG/20ML PHENOBARBITAL TABS 97.2MG POLYCIN OINT 500-10000UNIT/GM PREDNISOLONE SODIUM PHOSPHATE TBDP 30MG PROPOFOL EMUL 500MG/50ML PHENOHYTRO ELIX 16.2MG/5ML POLYMYXIN B SULFATE SOLR 500000UNIT PREDNISONE TABS 10MG HCL ER CP24 120MG PHENOHYTRO TABS 16.2MG POLYMYXIN B-TRIMETHOPRIM SOLN 10000-0.1UNIT/ML-% PREDNISONE TABS 1MG PROPRANOLOL HCL ER CP24 160MG PHENTERMINE HCL CAPS 15MG POSACONAZOLE TBEC 100MG PREDNISONE TABS 2.5MG PROPRANOLOL HCL ER CP24 60MG PHENTERMINE HCL CAPS 30MG POTASSIUM ACETATE SOLN 2MEQ/ML PREDNISONE TABS 20MG PROPRANOLOL HCL ER CP24 80MG PHENTERMINE HCL CAPS 37.5MG POTASSIUM CHLORIDE ER CPCR 10MEQ PREDNISONE TABS 5MG PROPRANOLOL HCL SOLN 1MG/ML PHENTERMINE HCL TABS 37.5MG POTASSIUM CHLORIDE ER CPCR 8MEQ PREDNISONE TBPK 10MG (21) PROPRANOLOL HCL TABS 10MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. PROPRANOLOL HCL TABS 20MG RANITIDINE HCL TABS 300MG ROCURONIUM BROMIDE SOLN 100MG/10ML SIMVASTATIN TABS 40MG PROPRANOLOL HCL TABS 40MG RANOLAZINE ER TB12 1000MG ROCURONIUM BROMIDE SOLN 50MG/5ML SIMVASTATIN TABS 5MG PROPRANOLOL HCL TABS 60MG RANOLAZINE ER TB12 500MG HCL ER TB24 12MG SIMVASTATIN TABS 80MG PROPRANOLOL HCL TABS 80MG RASAGILINE MESYLATE TABS 0.5MG ROPINIROLE HCL ER TB24 2MG SIROLIMUS TABS 1MG PROPYLTHIOURACIL TABS 50MG RASAGILINE MESYLATE TABS 1MG ROPINIROLE HCL ER TB24 4MG SOD CITRATE-CITRIC ACID SOLN 500-334MG/5ML HCL TABS 10MG RECLIPSEN TABS 0.15-30MG-MCG ROPINIROLE HCL ER TB24 6MG SODIUM ACETATE SOLN 4MEQ/ML PROTRIPTYLINE HCL TABS 5MG REMIFENTANIL HCL SOLR 1MG ROPINIROLE HCL ER TB24 8MG SODIUM BICARBONATE SOLN 4.2% PSEUDOEPH-BROMPHEN-DM SYRP 30-2-10MG/5ML REMIFENTANIL HCL SOLR 2MG ROPINIROLE HCL TABS 0.25MG SODIUM BICARBONATE SOLN 8.4% PYRAZINAMIDE TABS 500MG REMIFENTANIL HCL SOLR 5MG ROPINIROLE HCL TABS 0.5MG SODIUM CHLORIDE (PF) SOLN 0.9% PYRIDOSTIGMINE BROMIDE ER TBCR 180MG REPAGLINIDE TABS 0.5MG ROPINIROLE HCL TABS 1MG SODIUM CHLORIDE BACTERIOSTATIC SOLN 0.9% PYRIDOSTIGMINE BROMIDE SOLN 60MG/5ML REPAGLINIDE TABS 1MG ROPINIROLE HCL TABS 2MG SODIUM CHLORIDE FLUSH SOLN 0.9% PYRIDOSTIGMINE BROMIDE TABS 60MG REPAGLINIDE TABS 2MG ROPINIROLE HCL TABS 3MG SODIUM CHLORIDE NEBU 0.9% PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 1.5MG REVONTO SOLR 20MG ROPINIROLE HCL TABS 4MG SODIUM CHLORIDE NEBU 10% PRAMIPEXOLE DIHYDROCHLORIDE ER TB24 2.25MG RIFABUTIN CAPS 150MG ROPINIROLE HCL TABS 5MG SODIUM CHLORIDE NEBU 3% RIFAMPIN CAPS 150MG ROPIVACAINE HCL SOLN 10MG/ML SODIUM CHLORIDE NEBU 7% Q RIFAMPIN CAPS 300MG ROPIVACAINE HCL SOLN 2MG/ML SODIUM CHLORIDE SOLN 0.45% FUMARATE ER TB24 150MG RIFAMPIN SOLR 600MG ROPIVACAINE HCL SOLN 5MG/ML SODIUM CHLORIDE SOLN 0.9% QUETIAPINE FUMARATE ER TB24 200MG RIMANTADINE HCL TABS 100MG ROPIVACAINE HCL SOLN 7.5MG/ML SODIUM CHLORIDE SOLN 0.9% QUETIAPINE FUMARATE ER TB24 300MG RINGERS IRRIGATION SOLN ROSUVASTATIN CALCIUM TABS 10MG SODIUM CHLORIDE SOLN 2.5MEQ/ML QUETIAPINE FUMARATE ER TB24 400MG RINGERS SOLN ROSUVASTATIN CALCIUM TABS 20MG SODIUM CHLORIDE SOLN 3% QUETIAPINE FUMARATE ER TB24 50MG RISEDRONATE SODIUM TABS 150MG ROSUVASTATIN CALCIUM TABS 40MG SODIUM CHLORIDE SOLN 4MEQ/ML QUETIAPINE FUMARATE TABS 200MG RISEDRONATE SODIUM TABS 30MG ROSUVASTATIN CALCIUM TABS 5MG SODIUM CHLORIDE SOLN 5% QUETIAPINE FUMARATE TABS 25MG RISEDRONATE SODIUM TABS 35MG SODIUM FLUORIDE 5000 PLUS CREA 1.1% QUETIAPINE FUMARATE TABS 300MG RISEDRONATE SODIUM TABS 5MG S SODIUM FLUORIDE GEL 1.1% QUETIAPINE FUMARATE TABS 400MG RISEDRONATE SODIUM TBEC 35MG CREA 6% SODIUM FLUORIDE SOLN 1.1 (0.5 F)MG/ML QUETIAPINE FUMARATE TABS 50MG SOLN 1MG/ML SALICYLIC ACID ER SOLN 28.5% SODIUM PHOSPHATES SOLN 45MMOLE/15ML QUINAPRIL HCL TABS 10MG RISPERIDONE TABS 0.25MG SALICYLIC ACID FOAM 6% SODIUM POLYSTYRENE SULFONATE POWD QUINAPRIL HCL TABS 20MG RISPERIDONE TABS 0.5MG SALICYLIC ACID GEL 6% SODIUM POLYSTYRENE SULFONATE SUSP 15GM/60ML QUINAPRIL HCL TABS 40MG RISPERIDONE TABS 1MG SALICYLIC ACID SHAM 6% SODIUM POLYSTYRENE SULFONATE SUSP 30GM/120ML QUINAPRIL HCL TABS 5MG RISPERIDONE TABS 2MG SALICYLIC ACID WART REMOVER LIQD 27.5% SODIUM SULFACETAMIDE SHAM 10% QUINAPRIL-HYDROCHLOROTHIAZIDE TABS 10-12.5MG RISPERIDONE TABS 3MG SALICYLIC ACID-CLEANSER KIT 6% (CREAM) SODIUM SULFACETAMIDE WASH LIQD 10% QUINAPRIL-HYDROCHLOROTHIAZIDE TABS 20-12.5MG RISPERIDONE TABS 4MG SALSALATE TABS 500MG SOLIFENACIN SUCCINATE TABS 10MG QUINAPRIL-HYDROCHLOROTHIAZIDE TABS 20-25MG RISPERIDONE TBDP 0.5MG SALSALATE TABS 750MG SOLIFENACIN SUCCINATE TABS 5MG GLUCONATE ER TBCR 324MG RISPERIDONE TBDP 1MG SASH KIT KIT 100-0.9UNIT/ML-% HCL (AF) TABS 120MG QUININE SULFATE CAPS 324MG RISPERIDONE TBDP 2MG SCOPOLAMINE PT72 1MG/3DAYS SOTALOL HCL (AF) TABS 160MG RISPERIDONE TBDP 3MG SE-TAN PLUS CAPS 162-115.2-1MG SOTALOL HCL (AF) TABS 80MG R RISPERIDONE TBDP 4MG SELEGILINE HCL CAPS 5MG SOTALOL HCL TABS 120MG RABEPRAZOLE SODIUM TBEC 20MG RIVASTIGMINE PT24 13.3MG/24HR SELENIUM SULFIDE LOTN 2.5% SOTALOL HCL TABS 160MG RALOXIFENE HCL TABS 60MG RIVASTIGMINE PT24 4.6MG/24HR SELENIUM SULFIDE SHAM 2.25% SOTALOL HCL TABS 240MG RAMELTEON TABS 8MG RIVASTIGMINE PT24 9.5MG/24HR SELENIUM SULFIDE SHAM 2.3% SOTALOL HCL TABS 80MG RAMIPRIL CAPS 1.25MG RIVASTIGMINE TARTRATE CAPS 1.5MG SERTRALINE HCL CONC 20MG/ML TABS 100MG RAMIPRIL CAPS 10MG RIVASTIGMINE TARTRATE CAPS 3MG SEVELAMER CARBONATE PACK 0.8GM SPIRONOLACTONE TABS 25MG RAMIPRIL CAPS 2.5MG RIVASTIGMINE TARTRATE CAPS 4.5MG SEVELAMER CARBONATE PACK 2.4GM SPIRONOLACTONE TABS 50MG RAMIPRIL CAPS 5MG RIVASTIGMINE TARTRATE CAPS 6MG SEVELAMER CARBONATE TABS 800MG SPIRONOLACTONE-HCTZ TABS 25-25MG RANITIDINE HCL CAPS 150MG RIVELSA TABS 42-21-21-7DAYS SEVELAMER HCL TABS 800MG SSD CREA 1% RANITIDINE HCL CAPS 300MG RIZATRIPTAN BENZOATE TABS 10MG SEVOFLURANE SOLN SSS 10-5 CREA 10-5% RANITIDINE HCL SOLN 150MG/6ML RIZATRIPTAN BENZOATE TABS 5MG CITRATE TABS 100MG STERILE DILUENT/EPOPROSTENOL SOLN RANITIDINE HCL SOLN 50MG/2ML RIZATRIPTAN BENZOATE TBDP 10MG SILDENAFIL CITRATE TABS 25MG STERILE WATER FOR INJECTION SOLN RANITIDINE HCL TABS 150MG RIZATRIPTAN BENZOATE TBDP 5MG SILDENAFIL CITRATE TABS 50MG STERILE WATER FOR INJECTION SOLN

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. STERILE WATER FOR IRRIGATION SOLN TAZAROTENE CREA 0.1% THEOPHYLLINE ER TB24 400MG TORSEMIDE TABS 5MG SUBVENITE STARTER KIT-BLUE KIT 35 X 25MG TAZICEF SOLR 1GM THEOPHYLLINE ER TB24 600MG TRAMADOL HCL ER (BIPHASIC) TB24 100MG SUBVENITE STARTER KIT-GREEN KIT 84 X 25 MG &14X100 MG TAZICEF SOLR 2GM THEOPHYLLINE SOLN 80MG/15ML TRAMADOL HCL ER (BIPHASIC) TB24 200MG SUCCINYLCHOLINE CHLORIDE SOLN 20MG/ML TAZICEF SOLR 6GM THIAMINE HCL SOLN 100MG/ML TRAMADOL HCL ER (BIPHASIC) TB24 300MG SUCRALFATE TABS 1GM TELMISARTAN TABS 20MG HCL TABS 100MG TRAMADOL HCL ER TB24 100MG SUFENTANIL CITRATE SOLN 100MCG/2ML TELMISARTAN TABS 40MG THIORIDAZINE HCL TABS 10MG TRAMADOL HCL ER TB24 200MG SUFENTANIL CITRATE SOLN 250MCG/5ML TELMISARTAN TABS 80MG THIORIDAZINE HCL TABS 25MG TRAMADOL HCL ER TB24 300MG SUFENTANIL CITRATE SOLN 50MCG/ML TELMISARTAN-AMLODIPINE TABS 40-10MG THIORIDAZINE HCL TABS 50MG TRAMADOL HCL TABS 50MG SULFACETAMIDE SOD- WASH KIT 9-4.5% TELMISARTAN-AMLODIPINE TABS 40-5MG THIOTHIXENE CAPS 10MG TRAMADOL-ACETAMINOPHEN TABS 37.5-325MG SULFACETAMIDE SODIUM (ACNE) LOTN 10% TELMISARTAN-AMLODIPINE TABS 80-10MG THIOTHIXENE CAPS 1MG TRANDOLAPRIL TABS 1MG SULFACETAMIDE SODIUM GEL 10% (CLEANS) TELMISARTAN-AMLODIPINE TABS 80-5MG THIOTHIXENE CAPS 2MG TRANDOLAPRIL TABS 2MG SULFACETAMIDE SODIUM LIQD 10% TELMISARTAN-HCTZ TABS 40-12.5MG THIOTHIXENE CAPS 5MG TRANDOLAPRIL TABS 4MG SULFACETAMIDE SODIUM SOLN 10% TELMISARTAN-HCTZ TABS 80-12.5MG TIAGABINE HCL TABS 12MG TRANDOLAPRIL-VERAPAMIL HCL ER TBCR 2-180MG SULFACETAMIDE SODIUM-SULFUR CREA 10-2% TELMISARTAN-HCTZ TABS 80-25MG TIAGABINE HCL TABS 16MG TRANDOLAPRIL-VERAPAMIL HCL ER TBCR 2-240MG SULFACETAMIDE SODIUM-SULFUR CREA 9.8-4.8% TEMAZEPAM CAPS 15MG TIAGABINE HCL TABS 2MG TRANDOLAPRIL-VERAPAMIL HCL ER TBCR 4-240MG SULFACETAMIDE SODIUM-SULFUR LIQD 10-2% TEMAZEPAM CAPS 22.5MG TIAGABINE HCL TABS 4MG TRANEXAMIC ACID SOLN 1000MG/10ML SULFACETAMIDE SODIUM-SULFUR LIQD 9-4.5% TEMAZEPAM CAPS 30MG TIGECYCLINE SOLR 50MG TRANEXAMIC ACID TABS 650MG SULFACETAMIDE SODIUM-SULFUR LIQD 9-4% TEMAZEPAM CAPS 7.5MG TIMOLOL MALEATE SOLN 0.25% TRANYLCYPROMINE SULFATE TABS 10MG SULFACETAMIDE SODIUM-SULFUR LIQD 9.8-4.8% TEMOZOLOMIDE CAPS 100MG TIMOLOL MALEATE SOLN 0.5% HCL TABS 100MG SULFACETAMIDE SODIUM-SULFUR LOTN 9.8-4.8% TEMOZOLOMIDE CAPS 140MG TIMOLOL MALEATE SOLN 0.5% (DAILY) TRAZODONE HCL TABS 150MG SULFACETAMIDE SODIUM-SULFUR PADS 10-4% TEMOZOLOMIDE CAPS 180MG TIMOLOL MALEATE TABS 5MG TRAZODONE HCL TABS 300MG SULFACETAMIDE SODIUM-SULFUR SUSP 8-4% TEMOZOLOMIDE CAPS 20MG TINIDAZOLE TABS 250MG TRAZODONE HCL TABS 50MG SULFAMETHOXAZOLE-TRIMETHOPRIM SOLN 400-80MG/5ML TEMOZOLOMIDE CAPS 250MG TINIDAZOLE TABS 500MG TRETINOIN CREA 0.05% SULFAMETHOXAZOLE-TRIMETHOPRIM SUSP 200-40MG/5ML TEMOZOLOMIDE CAPS 5MG HCL CAPS 2MG TRETINOIN CREA 0.1% SULFAMETHOXAZOLE-TRIMETHOPRIM TABS 400-80MG HCL CAPS 10MG TIZANIDINE HCL CAPS 4MG TRETINOIN GEL 0.01% SULFAMETHOXAZOLE-TRIMETHOPRIM TABS 800-160MG TERAZOSIN HCL CAPS 1MG TIZANIDINE HCL CAPS 6MG TRETINOIN GEL 0.025% SULFASALAZINE TABS 500MG TERAZOSIN HCL CAPS 2MG TIZANIDINE HCL TABS 2MG TRETINOIN GEL 0.05% SULFASALAZINE TBEC 500MG TERAZOSIN HCL CAPS 5MG TIZANIDINE HCL TABS 4MG TRETINOIN MICROSPHERE GEL 0.04% SULINDAC TABS 150MG TERBINAFINE HCL TABS 250MG TL GARD RX TABS 2.2-25-1MG TRETINOIN MICROSPHERE GEL 0.1% SULINDAC TABS 200MG SULFATE SOLN 1MG/ML TL ICON CAPS TRI-LEGEST FE TABS 1-20/1-30/1-35MG-MCG SUMATRIPTAN SOLN 20MG/ACT TERBUTALINE SULFATE TABS 2.5MG TOBRAMYCIN SOLN 0.3% TRI-LO-SPRINTEC TABS 0.18/0.215/0.25MG-25 MCG SUMATRIPTAN SOLN 5MG/ACT TERBUTALINE SULFATE TABS 5MG TOBRAMYCIN SULFATE SOLN 1.2GM/30ML TRI-PREVIFEM TABS 0.18/0.215/0.25MG-35 MCG SUMATRIPTAN SUCCINATE REFILL SOCT 4MG/0.5ML TERCONAZOLE CREA 0.4% TOBRAMYCIN SULFATE SOLN 80MG/2ML TRI-VITAMIN/FLUORIDE SOLN 0.25MG/ML SUMATRIPTAN SUCCINATE REFILL SOCT 6MG/0.5ML TERCONAZOLE SUPP 80MG TOBRAMYCIN SULFATE SOLR 1.2GM TRI-VITAMIN/FLUORIDE SOLN 0.5MG/ML SUMATRIPTAN SUCCINATE SOAJ 4MG/0.5ML CYPIONATE SOLN 100MG/ML TOBRAMYCIN-DEXAMETHASONE SUSP 0.3-0.1% AERS 0.147MG/GM SUMATRIPTAN SUCCINATE SOAJ 6MG/0.5ML SOLN 200MG/ML TOLCAPONE TABS 100MG TRIAMCINOLONE ACETONIDE CREA 0.025% SUMATRIPTAN SUCCINATE SOLN 6MG/0.5ML SOLN 200MG/ML TOLTERODINE TARTRATE ER CP24 2MG TRIAMCINOLONE ACETONIDE CREA 0.1% SUMATRIPTAN SUCCINATE TABS 100MG TESTOSTERONE GEL 10 MG/ACT(2%) TOLTERODINE TARTRATE ER CP24 4MG TRIAMCINOLONE ACETONIDE CREA 0.5% SUMATRIPTAN SUCCINATE TABS 25MG TESTOSTERONE GEL 12.5 MG/ACT(1%) TOLTERODINE TARTRATE TABS 1MG TRIAMCINOLONE ACETONIDE LOTN 0.025% SUMATRIPTAN SUCCINATE TABS 50MG TESTOSTERONE GEL 20.25 MG/1.25GM(1.62%) TOLTERODINE TARTRATE TABS 2MG TRIAMCINOLONE ACETONIDE LOTN 0.1% SUMATRIPTAN-NAPROXEN SODIUM TABS 85-500MG TESTOSTERONE GEL 20.25 MG/ACT(1.62%) TOPIRAMATE CPSP 15MG TRIAMCINOLONE ACETONIDE OINT 0.025% TESTOSTERONE GEL 25 MG/2.5GM(1%) TOPIRAMATE CPSP 25MG TRIAMCINOLONE ACETONIDE OINT 0.1% T TESTOSTERONE GEL 40.5 MG/2.5GM(1.62%) TOPIRAMATE TABS 100MG TRIAMCINOLONE ACETONIDE OINT 0.5% OINT 0.03% TESTOSTERONE GEL 50 MG/5GM(1%) TOPIRAMATE TABS 200MG TRIAMCINOLONE ACETONIDE PSTE 0.1% TACROLIMUS OINT 0.1% TESTOSTERONE SOLN 30MG/ACT TOPIRAMATE TABS 25MG TRIAMCINOLONE ACETONIDE SUSP 40MG/ML TABS 10MG TETRACAINE HCL SOLN 0.5% TOPIRAMATE TABS 50MG TRIAMTERENE CAPS 100MG TADALAFIL TABS 2.5MG TETRACYCLINE HCL CAPS 250MG TORSEMIDE TABS 100MG TRIAMTERENE CAPS 50MG TADALAFIL TABS 20MG TETRACYCLINE HCL CAPS 500MG TORSEMIDE TABS 10MG TRIAMTERENE-HCTZ CAPS 37.5-25MG TADALAFIL TABS 5MG THEOPHYLLINE ER TB12 300MG TORSEMIDE TABS 20MG TRIAMTERENE-HCTZ TABS 37.5-25MG TAMSULOSIN HCL CAPS 0.4MG%

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. TRIAMTERENE-HCTZ TABS 75-50MG VALSARTAN TABS 80MG VITAMIN K1 SOLN 10MG/ML TRIAZOLAM TABS 0.125MG VALSARTAN-HYDROCHLOROTHIAZIDE TABS 160-12.5MG VITAMIN K1 SOLN 1MG/0.5ML TRIAZOLAM TABS 0.25MG VALSARTAN-HYDROCHLOROTHIAZIDE TABS 160-25MG VORICONAZOLE SOLR 200MG TRICITRATES SOLN 550-500-334MG/5ML VALSARTAN-HYDROCHLOROTHIAZIDE TABS 320-12.5MG VORICONAZOLE SUSR 40MG/ML TRIENTINE HCL CAPS 250MG VALSARTAN-HYDROCHLOROTHIAZIDE TABS 320-25MG VORICONAZOLE TABS 200MG HCL TABS 10MG VALSARTAN-HYDROCHLOROTHIAZIDE TABS 80-12.5MG VORICONAZOLE TABS 50MG TRIFLUOPERAZINE HCL TABS 1MG VANCOMYCIN HCL CAPS 125MG TRIFLUOPERAZINE HCL TABS 2MG VANCOMYCIN HCL CAPS 250MG W TRIFLUOPERAZINE HCL TABS 5MG VANCOMYCIN HCL SOLR 10GM WARFARIN SODIUM TABS 10MG TRIGELS-F FORTE CAPS 460-60-0.01-1MG VANCOMYCIN HCL SOLR 1GM WARFARIN SODIUM TABS 1MG TRIHEXYPHENIDYL HCL SOLN 0.4MG/ML VANCOMYCIN HCL SOLR 500MG WARFARIN SODIUM TABS 2.5MG TRIHEXYPHENIDYL HCL TABS 2MG VANCOMYCIN HCL SOLR 5GM WARFARIN SODIUM TABS 2MG TRIHEXYPHENIDYL HCL TABS 5MG VANCOMYCIN HCL SOLR 750MG WARFARIN SODIUM TABS 3MG TRIMETHOBENZAMIDE HCL CAPS 300MG VANDAZOLE GEL 0.75% WARFARIN SODIUM TABS 4MG TRIMETHOPRIM TABS 100MG HCL TABS 10MG WARFARIN SODIUM TABS 5MG MALEATE CAPS 100MG VARDENAFIL HCL TABS 2.5MG WARFARIN SODIUM TABS 6MG TRIMIPRAMINE MALEATE CAPS 25MG VARDENAFIL HCL TABS 20MG WARFARIN SODIUM TABS 7.5MG TRIMIPRAMINE MALEATE CAPS 50MG VARDENAFIL HCL TABS 5MG TROPICAMIDE SOLN 0.5% VARDENAFIL HCL TBDP 10MG X TROPICAMIDE SOLN 1% VECURONIUM BROMIDE SOLR 10MG XYLOCAINE DENTAL SOLN 2%-1:50000 TROSPIUM CHLORIDE ER CP24 60MG VECURONIUM BROMIDE SOLR 20MG TROSPIUM CHLORIDE TABS 20MG VELIVET TABS 0.1/0.125/0.15-0.025 MG Z VENLAFAXINE HCL ER CP24 150MG ZAFIRLUKAST TABS 10MG U VENLAFAXINE HCL ER CP24 37.5MG ZAFIRLUKAST TABS 20MG UMECTA MOUSSE FOAM 40% VENLAFAXINE HCL ER CP24 75MG ZALEPLON CAPS 10MG CREA 39% VENLAFAXINE HCL ER TB24 150MG ZALEPLON CAPS 5MG UREA CREA 40% VENLAFAXINE HCL ER TB24 225MG ZIDOVUDINE TABS 300MG UREA CREA 41% VENLAFAXINE HCL ER TB24 37.5MG ZILEUTON ER TB12 600MG UREA CREA 47% VENLAFAXINE HCL ER TB24 75MG HCL CAPS 20MG UREA HYDRATING FOAM 35% VENLAFAXINE HCL TABS 100MG ZIPRASIDONE HCL CAPS 40MG UREA NAIL GEL 45% VENLAFAXINE HCL TABS 25MG ZIPRASIDONE HCL CAPS 60MG URO-458 TABS 81MG VENLAFAXINE HCL TABS 37.5MG ZIPRASIDONE HCL CAPS 80MG UROAV-B CAPS 118MG VENLAFAXINE HCL TABS 50MG ZOLEDRONIC ACID SOLN 5MG/100ML URSODIOL CAPS 300MG VENLAFAXINE HCL TABS 75MG ZOLMITRIPTAN TABS 2.5MG URSODIOL TABS 250MG VERAPAMIL HCL ER CP24 120MG ZOLMITRIPTAN TABS 5MG URSODIOL TABS 500MG VERAPAMIL HCL ER CP24 180MG ZOLMITRIPTAN TBDP 2.5MG URYL TABS 81.6MG VERAPAMIL HCL ER CP24 200MG ZOLMITRIPTAN TBDP 5MG USTELL CAPS 120MG VERAPAMIL HCL ER CP24 240MG ZOLPIDEM TARTRATE ER TBCR 12.5MG VERAPAMIL HCL ER TBCR 120MG ZOLPIDEM TARTRATE ER TBCR 6.25MG V VERAPAMIL HCL ER TBCR 180MG ZOLPIDEM TARTRATE SUBL 1.75MG V-C FORTE CAPS VERAPAMIL HCL ER TBCR 240MG ZOLPIDEM TARTRATE SUBL 3.5MG VALACYCLOVIR HCL TABS 1GM VERAPAMIL HCL SOLN 2.5MG/ML ZOLPIDEM TARTRATE TABS 10MG VALACYCLOVIR HCL TABS 500MG VERAPAMIL HCL TABS 120MG ZOLPIDEM TARTRATE TABS 5MG SODIUM SOLN 500MG/5ML VERAPAMIL HCL TABS 40MG ZONISAMIDE CAPS 100MG VALPROIC ACID CAPS 250MG VERAPAMIL HCL TABS 80MG ZONISAMIDE CAPS 25MG VALPROIC ACID SOLN 250MG/5ML VICODIN HP TABS 10-300MG ZONISAMIDE CAPS 50MG VALSARTAN TABS 160MG VICODIN TABS 5-300MG VALSARTAN TABS 320MG VITAMIN B-COMPLEX 100 INJ VALSARTAN TABS 40MG VITAMIN D (ERGOCALCIFEROL) CAPS 1.25 MG(50000 UT)

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. ADVAIR HFA AERO 115-21MCG/ACT AMCINONIDE CREA 0.1% ANTIMONY TRISULFIDE POWD # ANTIPYRINE CRYS 2-DEOXY-D-GLUCOSE POWD ADVAIR HFA AERO 230-21MCG/ACT AMCINONIDE LOTN 0.1% APAP-CAFF-DIHYDROCODEINE CAPS 320.5-30-16MG 2-METHOXYESTRADIOL POWD ADVAIR HFA AERO 45-21MCG/ACT AMIKACIN SULFATE POWD APEXICON E CREA 0.05% 4-AMINOBUTYRIC ACID CRYS ADYNOVATE SOLR 1000UNIT AMINOBENZOIC ACID POWD APLISOL SOLN 5UNIT/0.1ML 4-AMINOPYRIDINE POWD ADYNOVATE SOLR 2000UNIT AMINOCAPROIC ACID POWD HCL POWD 4-METHYLPYRAZOLE LIQD ADYNOVATE SOLR 250UNIT AMINOPHYLLINE POWD APPLE FLAVOR POWD 5-METHYLTETRAHYDROFOLATE CALC POWD ADYNOVATE SOLR 500UNIT AMINOSALICYLIC ACID-4 POWD AQUACEL AG BURN PADS 4"X5" 7-KETO DHEA POWD AEROCHAMBER PLUS FLO-VU SMALL MISC AMINOSALICYLIC ACID-5 POWD AEROTRACH PLUS MISC AMINOSYN II SOLN 15% AQUASOL A SOLN 50000UNIT/ML ALBENDAZOLE POWD AMINOSYN-PF SOLN 7% ARGININE HCL POWD A ARLACEL 165 POWD ABELCET SUSP 5MG/ML ALBUTEROL SULFATE ER TB12 4MG AMITRIPTYLINE HCL POWD ARMOUR THYROID TABS 120MG ACACIA POWD ALBUTEROL SULFATE ER TB12 8MG AMLODIPINE BESYLATE POWD ARMOUR THYROID TABS 15MG ACCU-CHEK SPIRIT BATTERY KIT MISC ALBUTEROL SULFATE HFA AERS 108 (90 BASE)MCG/ACT AMMONIUM BROMIDE GRAN ARMOUR THYROID TABS 180MG ACCU-CHEK TENDER 1 INFUSION KIT ALBUTEROL SULFATE POWD AMMONIUM CHLORIDE GRAN ARMOUR THYROID TABS 240MG ACCU-CHEK TENDER I SET 43" MISC ALCOHOL, USP SOLN 95% AMMONIUM HYDROXIDE SOLN ARMOUR THYROID TABS 300MG ACD FORMULA A SOLN 0.73-2.45-2.2GM/100ML ALENDRONATE SODIUM SOLN 70MG/75ML AMMONIUM LACTATE SOLN 70% ARMOUR THYROID TABS 30MG ACEBUTOLOL HCL POWD ALENDRONATE SODIUM TABS 40MG AMMONIUM LAURYL SULFATE LIQD 28% ARMOUR THYROID TABS 60MG ACEPROMAZINE MALEATE POWD ALGINIC ACID POWD AMMONIUM MOLYBDATE TETRAHYD POWD ARMOUR THYROID TABS 90MG ACESULFAME POTASSIUM POWD ALINIA SUSR 100MG/5ML AMMONIUM SULFATE GRAN ARNICA FLOWER TINC ACETAMINOPHEN GRAN ALKYL ACRYLATE CROSSPOLYMER POWD TABS 100MG ARNUITY ELLIPTA AEPB 100MCG/ACT ACETAMINOPHEN POWD ALKYL BENZOATE C12-15 LIQD AMOXAPINE TABS 150MG ARNUITY ELLIPTA AEPB 200MCG/ACT ACETAZOLAMIDE POWD ALLANTOIN POWD AMOXAPINE TABS 25MG ARNUITY ELLIPTA AEPB 50MCG/ACT Tier 3 ACETIC ACID GLACIAL SOLN 99% ALLOPURINOL POWD AMOXAPINE TABS 50MG ARSENIC TRIOXIDE POWD Preferred Brand: ACETIC ACID SOLN 5% ALMOND OIL (SWEET) OIL AMOXICILLIN CHEW 125MG ASCORBIC ACID GRAN $50.00- After ACETONE SOLN ALOE VERA OIL AMOXICILLIN CHEW 250MG ASCORBIC ACID POWD deductible ACETYL HEXAPEPTIDE-8 SOLN ALOE VERA POWD AMOXICILLIN TRIHYDRATE POWD ASCORBYL PALMITATE POWD ACETYL SALICYLIC ACID POWD ALOPRIM SOLR 500MG AMOXICILLIN-POT CLAVULANATE CHEW 200-28.5MG ASPARAGINE MONOHYDRATE POWD ACETYL-D-GLUCOSAMINE POWD ALPHA-KETOGLUTARIC ACID POWD AMOXICILLIN-POT CLAVULANATE CHEW 400-57MG ASPARTAME POWD ACETYL-L-CARNITINE HCL POWD ALPHA-LIPOIC ACID POWD AMOXICILLIN-POT CLAVULANATE ER TB12 1000-62.5MG ATENOLOL POWD ACETYLCHOLINE CHLORIDE POWD ALPHA-TOCOPHEROL LIQD AMPHOTERICIN B POWD ATROPINE SULFATE MONOHYDRATE POWD ACETYLCYSTEINE POWD ALPHAGAN P SOLN 0.1% AMPHOTERICIN B SOLR 50MG ATROPINE SULFATE OINT 1% ACIDOPHILUS LACTOBACILLUS POWD ALPHANATE/VWF COMPLEX/HUMAN SOLR 1000UNIT AMPICILLIN CAPS 500MG ATROPINE SULFATE POWD ACTHIB SOLR ALPHANATE/VWF COMPLEX/HUMAN SOLR 1500UNIT AMPICILLIN SODIUM SOLR 125MG ATROPINE SULFATE SOLN 0.4MG/ML ACTHREL SOLR 100MCG ALPHANATE/VWF COMPLEX/HUMAN SOLR 2000UNIT AMPICILLIN SODIUM SOLR 1GM ATROPINE SULFATE SOLN 1% ACTICOAT 7 PADS 4"X5" ALPHANATE/VWF COMPLEX/HUMAN SOLR 250UNIT AMPICILLIN-SULBACTAM SODIUM SOLR 1.5 (1-0.5)GM ATROPINE SULFATE SOLN 1MG/ML ACTIVASE SOLR 100MG ALPHANATE/VWF COMPLEX/HUMAN SOLR 500UNIT AMPICILLIN-SULBACTAM SODIUM SOLR 3 (2-1)GM ATROPINE SULFATE SOLN 8MG/20ML ACTIVASE SOLR 50MG ALPHANINE SD SOLR 1500UNIT AMYTAL SODIUM SOLR 500MG ATROPINE SULFATE SOSY 0.25MG/5ML ACYCLOVIR POWD ALPHANINE SD SOLR 500UNIT ANASPAZ TBDP 0.125MG ATROPINE SULFATE SOSY 0.5MG/5ML ADACEL SUSP 5-2-15.5LF-MCG/0.5 ALPRAZOLAM INTENSOL CONC 1MG/ML ANASTROZOLE POWD ATROPINE SULFATE SOSY 0.8MG/2ML ADAPALENE PADS 0.1% ALPRAZOLAM POWD ANDRODERM PT24 2MG/24HR ATTAPULGITE POWD ADAPALENE SOLN 0.1% ALPROSTADIL POWD ANDRODERM PT24 4MG/24HR AUGMENTIN SUSR 125-31.25MG/5ML ADENOSINE POWD ALUMINUM ACETATE BASIC POWD POWD AVO CREAM EMUL ADENOSINE-5-TRIPHOSPHATE POWD ALUMINUM CHLORIDE ANHYDROUS POWD ANECTINE SOLN 20MG/ML AVOCADO OIL OIL ADRENALIN SOLN 1MG/ML ALUMINUM CHLORIDE HEXAHYDRATE CRYS ANHYDROUS BASE OINT AVYCAZ SOLR 2.5 (2-0.5)GM ADRENALIN SOLN 30MG/30ML ALUMINUM CHLOROHYDRATE POWD ANHYDROUS CREAM BASE CREA AZASITE SOLN 1% ADRENOCORTICOTROPHIC HORMONE POWD ALUMINUM HYDROXIDE DRIED GEL POWD ANISINDIONE POWD AZATHIOPRINE POWD ADVAIR DISKUS AEPB 100-50MCG/DOSE ALUMINUM POTASSIUM SULFATE POWD ANORO ELLIPTA AEPB 62.5-25MCG/INH AZELAIC ACID FLAK ADVAIR DISKUS AEPB 250-50MCG/DOSE ALUMINUM SULFATE GRAN ANTHRALIN POWD AZITHROMYCIN PACK 1GM ADVAIR DISKUS AEPB 500-50MCG/DOSE AMANTADINE HCL POWD ANTIMONY TRICHLORIDE CRYS AZITHROMYCIN POWD

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. B BELVIQ XR TB24 20MG BLUE AGAVE ORGANIC LIQD C BENACTYZINE HCL POWD BORIC ACID GRAN B-COMPLEX INJ C-NATE DHA CAPS 28-1-200MG BENAZEPRIL HCL POWD BORIC ACID POWD BACITRACIN MICRONIZED POWD CAFFEINE ANHYDROUS POWD BENTONITE POWD BORON CITRATE POWD 5% BACITRACIN OINT 500UNIT/GM CAFFEINE CITRATED POWD SOLN BOSWELLIA SERRATA EXTRACT POWD BACITRACIN POWD CAFFEINE-SODIUM BENZOATE SOLN 125-125MG/ML BENZALKONIUM CHLORIDE SOLN 50% BP CLEANSING WASH EMUL 10-4% BACITRACIN POWD CALAMINE POWD POWD BP VIT 3 CAPS 1MG BACLOFEN POWD CALCITRIOL IN ALMOND OIL OIL 1000NANOGM/ML BENZNIDAZOLE TABS 100MG BPO GEL 4% BACTERIOSTATIC WATER(BENZ ALC) SOLN CALCITRIOL OINT 3MCG/GM BENZNIDAZOLE TABS 12.5MG BPO GEL 8% BACTOCILL IN DEXTROSE SOLN 1GM/50ML CALCITRIOL SOLN 1MCG/ML BENZOCAINE POWD BREO ELLIPTA AEPB 100-25MCG/INH BACTOCILL IN DEXTROSE SOLN 2GM/50ML CALCIUM ACETATE POWD BENZOIC ACID CRYS BREO ELLIPTA AEPB 200-25MCG/INH BAL IN OIL SOLN 100MG/ML CALCIUM ALGINATE POWD BENZOIC ACID POWD BREVITAL SODIUM SOLR 2.5GM BAL-CARE DHA MISC 27-1 & 430MG CALCIUM ASCORBATE POWD BENZOIN GUM POWD BREVITAL SODIUM SOLR 500MG BANANA CREAM FLAVOR LIQD CALCIUM CARBONATE POWD BENZOIN TINC BRIJ 35 WAX BANZEL TABS 200MG CALCIUM CHLORIDE ANHYDROUS POWD BENZOQUINONE (PARA) CRYS BRIJ 700 WAX BANZEL TABS 400MG CALCIUM CHLORIDE DIHYDRATE GRAN BENZOYL PEROXIDE HYDROUS POWD BRIJ 93 LIQD BAQSIMI ONE PACK POWD 3MG/DOSE CALCIUM CHLORIDE DIHYDRATE POWD BENZPHETAMINE HCL TABS 25MG BRILINTA TABS 60MG BARIUM SULFATE POWD CALCIUM CHLORIDE SOLN 10% BENZYL ALCOHOL LIQD BRILINTA TABS 90MG BASE GELATIN GUMMY TROCHE GEL CALCIUM CITRATE POWD BENZYL BENZOATE LIQD BRILLIANT GREEN POWD BASE X FLAK CALCIUM DISODIUM VERSENATE SOLN 1GM/5ML BETA CAROTENE BEAD 10% BRIMONIDINE TARTRATE POWD BASIC FUCHSIN HCL POWD CALCIUM GLUBIONATE POWD BETA CYCLODEXTRIN POWD BROMELAIN POWD BAXDELA SOLR 300MG CALCIUM GLUCONATE ANHYDROUS POWD BETA GLUCAN POWD BROMFENAC SODIUM (ONCE-DAILY) SOLN 0.09% BAXDELA TABS 450MG CALCIUM GLUCONATE-NACL SOLN 1-0.9GM/100ML-% BETAHISTINE HCL POWD BROMHEXINE HCL POWD BCG VACCINE INJ CALCIUM HYDROXIDE POWD BETAINE ANHYDROUS POWD BROMOCRIPTINE MESYLATE POWD BD INSULIN SYRINGE U-500 MISC 31G X 6MM0.5 ML CALCIUM LACTATE PENTAHYDRATE POWD BETAINE HCL POWD BROMPHENIRAMINE MALEATE POWD BD PEN NEEDLE NANO U/F MISC 32G X 4 MM CALCIUM LEVULINATE DIHYDRATE POWD BETAMETHASONE ACETATE POWD BSS SOLN BD SAFETYGLIDE INSULIN SYRINGE MISC 31G X 15/64"0.3 ML CALCIUM PANTOTHENATE POWD BETAMETHASONE DIPROPIONATE AUG GEL 0.05% BUDESONIDE POWD BD SAFETYGLIDE SHIELDED NEEDLE MISC 22G X 1-1/2"10 ML CALCIUM PHOSPHATE DIBASIC POWD BETAMETHASONE DIPROPIONATE POWD HCL POWD BD SYRINGE BLUNT CANNULA 17G MISC 5 ML CALCIUM PHOSPHATE TRIBASIC POWD BETAMETHASONE SODIUM PHOSPHATE POWD BUPIVACAINE FISIOPHARMA SOLN 2.5MG/ML BD SYRINGE LUER-LOK MISC 30 ML CALCIUM PYRUVATE POWD BETAMETHASONE VALERATE POWD BUPIVACAINE FISIOPHARMA SOLN 5MG/ML BD SYRINGE TIP CAP MISC CALCIUM SACCHARIN CRYS BETANAPHTHOL POWD 99% BUPIVACAINE HCL POWD BECLOMETHASONE DIPROPIONATE POWD CALCIUM SULFATE HEMIHYDRATE POWD BETHANECHOL CHLORIDE POWD BUPRENORPHINE HCL POWD BEES WAX WAX CALCIUM THIOGLYCOLATE POWD BEVESPI AEROSPHERE AERO 9-4.8MCG/ACT BUPRENORPHINE PTWK 7.5MCG/HR BEESWAX (YELLOW) WAX CALCIUM-FOLIC ACID PLUS D WAFR 1342-1MG BHA FLAK BUPROPION HCL POWD BELBUCA FILM 150MCG CALDOLOR SOLN 800MG/8ML BHT GRAN BUSPIRONE HCL POWD BELBUCA FILM 300MCG CAMINO PRO COMPLETE/GLYTACTIN BAR BICILLIN L-A SUSP 1200000UNIT/2ML BUTALBITAL POWD BELBUCA FILM 450MCG CAMINO PRO PKU LIQD BICILLIN L-A SUSP 2400000UNIT/4ML BUTALBITAL-ACETAMINOPHEN CAPS 50-300MG BELBUCA FILM 600MCG CAMPHOR CRYS BICILLIN L-A SUSP 600000UNIT/ML BUTORPHANOL TARTRATE POWD BELBUCA FILM 750MCG CAMPHOR GRAN BIOLON SOLN 10MG/ML BUTORPHANOL TARTRATE SOLN 1MG/ML BELBUCA FILM 75MCG CANDIN SOLN BIOTHRAX SUSP BUTYL ALCOHOL LIQD BELBUCA FILM 900MCG CANTHARIDIN POWD BIOTIN POWD POWD BELLADONNA ALKALOIDS-OPIUM SUPP 16.2-30MG CAPASTAT SULFATE SOLR 1GM BISABOLOL, ALPHA-L LIQD BUTYLATED HYDROXYTOLUENE POWD BELLADONNA ALKALOIDS-OPIUM SUPP 16.2-60MG CAPRYLIC ACID LIQD BISACODYL POWD BUTYLENE GLYCOL LIQD BELLADONNA EXTRACT POWD CAPRYLIC CAPRIC TRIGLYCERIDE LIQD BISMUTH CITRATE POWD BYSTOLIC TABS 10MG BELLADONNA TINC CAPSAICIN POWD 95% BISMUTH SUBCARBONATE POWD BYSTOLIC TABS 2.5MG BELSOMRA TABS 10MG CAPSICUM OLEORESIN LIQD BISMUTH SUBGALLATE POWD BYSTOLIC TABS 20MG BELSOMRA TABS 15MG CAPSUBLEND-S POWD BISMUTH SUBNITRATE POWD BYSTOLIC TABS 5MG BELSOMRA TABS 20MG CAPSULE CONI-SNAP #0 CLEAR CAPS BISMUTH SUBSALICYLATE POWD BELSOMRA TABS 5MG CAPSULE CONI-SNAP #3 CLEAR CAPS BITTER DRUG POWD BELVIQ TABS 10MG CAPTOPRIL POWD

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. CAPTOPRIL-HYDROCHLOROTHIAZIDE TABS 25-15MG CEFTAZIDIME AND DEXTROSE SOLR 1-5GM-%(50ML) CHLOROTHIAZIDE TABS 250MG CLEOCIN PHOSPHATE SOLN 300MG/2ML CAPTOPRIL-HYDROCHLOROTHIAZIDE TABS 25-25MG CEFTAZIDIME AND DEXTROSE SOLR 2-5GM-%(50ML) CHLOROTHIAZIDE TABS 500MG CLIDINIUM BROMIDE POWD CAPTOPRIL-HYDROCHLOROTHIAZIDE TABS 50-15MG CEFTAZIDIME WITH SOD CARBONATE POWD CHLOROXINE POWD CLINDAMYCIN HCL POWD CAPTOPRIL-HYDROCHLOROTHIAZIDE TABS 50-25MG CEFTRIAXONE SODIUM IN DEXTROSE SOLN 20MG/ML POWD CLINDAMYCIN PHOSPHATE POWD CARBACHOL POWD 99% CEFTRIAXONE SODIUM IN DEXTROSE SOLN 40MG/ML CHLORPHENIRAMINE MALEATE POWD CLINIMIX E/DEXTROSE (2.75/5) SOLN 2.75% CARBAMAZEPINE POWD CEFTRIAXONE SODIUM POWD CHLORPROMAZINE HCL POWD CLINIMIX E/DEXTROSE (4.25/10) SOLN 4.25% CARBAMIDE PEROXIDE POWD CEFTRIAXONE SODIUM-DEXTROSE SOLR 1-3.74GM-%(50ML) CHLORPROMAZINE HCL SOLN 25MG/ML CLINIMIX E/DEXTROSE (4.25/5) SOLN 4.25% CARBAZOCHROME POWD CEFTRIAXONE SODIUM-DEXTROSE SOLR 2-2.22GM-%(50ML) CHLORPROMAZINE HCL SOLN 50MG/2ML CLINIMIX E/DEXTROSE (5/15) SOLN 5% CARBIDOPA ANHYDROUS POWD CELECOXIB POWD CHLORZOXAZONE TABS 250MG CLINIMIX E/DEXTROSE (5/20) SOLN 5% CARBIDOPA-LEVODOPA-ENTACAPONE TABS 12.5-50-200MG CELLULASE POWD 5000UNIT/GM CHLORZOXAZONE TABS 375MG CLINIMIX/DEXTROSE (4.25/10) SOLN 4.25% CARBIDOPA-LEVODOPA-ENTACAPONE TABS 18.75-75-200MG CELLULOSE CARMELLOSE SODIUM POWD CHLORZOXAZONE TABS 500MG CLINIMIX/DEXTROSE (4.25/25) SOLN 4.25% CARBIDOPA-LEVODOPA-ENTACAPONE TABS 25-100-200MG CELLULOSE CRYS CHLORZOXAZONE TABS 750MG CLINIMIX/DEXTROSE (4.25/5) SOLN 4.25% CARBIDOPA-LEVODOPA-ENTACAPONE TABS 31.25-125-200MG CELLULOSE POWD CHOLECALCIFEROL CRYS CLINIMIX/DEXTROSE (5/15) SOLN 5% CARBIDOPA-LEVODOPA-ENTACAPONE TABS 37.5-150-200MG CELONTIN CAPS 300MG CHOLESTEROL FLAK CLINIMIX/DEXTROSE (5/20) SOLN 5% CARBIDOPA-LEVODOPA-ENTACAPONE TABS 50-200-200MG CEM-UREA SOLN 45% CHOLESTEROL POWD CLINIMIX/DEXTROSE (5/25) SOLN 5% CARBIMAZOLE POWD CENTRATEX CAPS 106-1MG CHOLESTYRAMINE POWD POWD CARBINOXAMINE MALEATE TABS 6MG CEPHALEXIN TABS 250MG CHOLINE BITARTRATE POWD CLOBETASOL 17 PROPIONATE POWD CARBOCAINE PRESERVATIVE-FREE SOLN 1.5% CEPHALEXIN TABS 500MG CHOLINE CHLORIDE POWD CLOFAZIMINE POWD CARBOMER 934P RESIN POWD CERESIN WAX FLAK CHOLINE MAG TRISALICYLATE POWD CLOMIPHENE CITRATE POWD CARBOXYMETHYLCELLULOSE SODIUM GRAN CESIUM CHLORIDE POWD CHONDROITIN SULFATE SODIUM POWD CLOMIPRAMINE HCL POWD CARBOXYMETHYLCELLULOSE SODIUM POWD CETEARYL ALCOHOL-CETEARETH 20 POWD CHORIONIC GONADOTROPIN POWD CLONAZEPAM POWD CARISOPRODOL POWD CETYL ALCOHOL FLAK CHROMIC CHLORIDE SOLN 40MCG/10ML CLONIDINE HCL POWD CARNAUBA WAX FLAK CETYL ALCOHOL POWD CHROMIUM PICOLINATE POWD CLOTRIMAZOLE CRYS CARNITINE (L) POWD CETYL ESTERS WAX WAX CHRYSIN POWD CLOTRIMAZOLE POWD CARNOSINE L POWD CETYL MYRISTOLEATE OIL 40% CHYMOTRYPSIN (ALPHA) POWD CLOVE OIL OIL HCL SOLN 1% CETYL MYRISTOLEATE POWD CICLOPIROX OLAMINE POWD CLOZAPINE TABS 200MG CASTOR OIL OIL CETYL MYRISTOLEATE POWD 20% CIFEREX CAPS 1-3775MG-UNIT CLOZAPINE TABS 50MG CATHFLO ACTIVASE SOLR 2MG CETYL MYRISTOLEATE WAX 40% CIMETIDINE HCL SOLN 300MG/5ML EXTRACT SOLN 20% CAVERJECT IMPULSE KIT 10MCG CRYS CIMETIDINE POWD COAL TAR SOLN 20% CAVERJECT IMPULSE KIT 20MCG CHANTIX CONTINUING MONTH PAK TABS 1MG CINNAMON BARK POWD COAL TAR TAR CAVERJECT SOLR 40MCG CHANTIX STARTING MONTH PAK TABS 0.5 MG X 11 &1 MG X 42 CINVANTI EMUL 130MG/18ML COARTEM TABS 20-120MG CEDAR LEAF OIL OIL CHANTIX TABS 0.5MG CIPROFLOXACIN HCL POWD COBAMAMIDE POWD CEFACLOR ER TB12 500MG CHARCOAL ACTIVATED POWD CIPROFLOXACIN HCL SOLN 0.2% COCAINE HCL POWD CEFACLOR SUSR 125MG/5ML CHERRY SYRP CIPROFLOXACIN HCL TABS 100MG COCAINE HCL SOLN 4% CEFACLOR SUSR 250MG/5ML CHLORAL HYDRATE CRYS CIPROFLOXACIN POWD COCAMIDE DEA LIQD CEFACLOR SUSR 375MG/5ML CHLORAMBUCIL POWD CISATRACURIUM BESYLATE SOLN 10MG/ML COCOA BUTTER MISC CEFAZOLIN SODIUM SOLR 100GM CHLORAMPHENICOL CRYS CISATRACURIUM BESYLATE SOLN 2MG/ML COCONUT OIL OIL CEFAZOLIN SODIUM SOLR 1GM CHLORAMPHENICOL PALMITATE POWD CITRIC ACID ANHYDROUS GRAN COD LIVER OIL OIL CEFAZOLIN SODIUM SOLR 300GM CHLORAMPHENICOL POWD CITRIC ACID ANHYDROUS POWD CODEINE PHOSPHATE POWD CEFAZOLIN SODIUM-DEXTROSE SOLN 1-4GM/50ML-% CHLORAMPHENICOL SOD SUCCINATE SOLR 1GM CITRIC ACID MONOHYDRATE POWD CODEINE SULFATE TABS 30MG CEFAZOLIN SODIUM-DEXTROSE SOLR 1-4GM-%(50ML) CHLORDIAZEPOXIDE-AMITRIPTYLINE TABS 10-25MG CITRONELLA OIL OIL CODEINE SULFATE TABS 60MG CEFAZOLIN SODIUM-DEXTROSE SOLR 2-3GM-%(50ML) CHLORDIAZEPOXIDE-AMITRIPTYLINE TABS 5-12.5MG CITRUS BIOFLAVONOIDS POWD 13% COENZYME Q10 POWD CEFDITOREN PIVOXIL TABS 200MG CHLORHEXIDINE DIACETATE POWD CLARITHROMYCIN POWD COLCHICINE POWD CEFDITOREN PIVOXIL TABS 400MG CHLORHEXIDINE GLUCONATE SOLN CLARITHROMYCIN SUSR 125MG/5ML COLCHICINE TABS 0.6MG CEFEPIME HCL SOLN 1GM/50ML CHLORHEXIDINE GLUCONATE SOLN 20% CLARITHROMYCIN SUSR 250MG/5ML COLISTIMETHATE SODIUM POWD CEFEPIME HCL SOLN 2GM/100ML CHLOROACETIC ACID POWD CLEMASTINE FUMARATE POWD COLLAGEN HYDROLYSATE POWD CEFOTAXIME SODIUM SOLR 500MG CHLOROBUTANOL ANHYDROUS POWD CLEMASTINE FUMARATE TABS 2.68MG COLLAGENASE POWD CEFOXITIN SODIUM-DEXTROSE SOLR 1-4GM-%(50ML) CHLOROQUINE PHOSPHATE POWD CLEMIZOLE HCL POWD COLLODION FLEXIBLE LIQD CEFOXITIN SODIUM-DEXTROSE SOLR 2-2.2GM-%(50ML) CHLOROQUINE PHOSPHATE TABS 250MG CLENPIQ SOLN 10-3.5-12 MG-GM-GM/160ML COLLODION LIQD

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. DEXCOM G5 MOB/G4 PLAT SENSOR MISC COMBIGAN SOLN 0.2-0.5% CYCLOSPORINE A POWD DIHYDROXYACETONE (1,3) DIMER POWD DEXILANT CPDR 30MG COMBIPATCH PTTW 0.05-0.14MG/DAY CYPROHEPTADINE HCL POWD DIINDOLYLMETHANE POWD DEXILANT CPDR 60MG COMBIPATCH PTTW 0.05-0.25MG/DAY CYSTEAMINE HCL POWD DIIODO-L-THYRONINE 3,5 POWD DEXPANTHENOL POWD COMBIVENT RESPIMAT AERS 20-100MCG/ACT CYTOGAM INJ 50MG/ML DILANTIN CAPS 30MG DEXTROMETHORPHAN HBR MONOHYD CRYS COMPLETE NATAL DHA MISC 29-1-200 & 250MG DILATRATE-SR CPCR 40MG DEXTROMETHORPHAN HBR POWD COMPLETENATE CHEW 29-1MG D DILT-XR CP24 120MG COPPER CHLORIDE SOLN 0.4MG/ML DEXTROSE 5%/ELECTROLYTE #48 SOLN D-MANNOSE POWD DILTIAZEM HCL POWD COPPER GLUCONATE POWD DEXTROSE POWD D-PENAMINE TABS 125MG DILTIAZEM HCL SOLR 100MG COPPER GLYCINATE POWD DEXTROSE SOLN 20% D-XYLOSE POWD DILUENT FOR TREPROSTINIL SOLN COPPER PEPTIDE POWD DEXTROSE SOLN 250MG/ML DALIRESP TABS 250MCG DIMENHYDRINATE POWD CORAL CALCIUM POWD DEXTROSE SOLN 30% DALIRESP TABS 500MCG DIMENHYDRINATE SOLN 50MG/ML CORLANOR SOLN 5MG/5ML DEXTROSE SOLN 40% DALVANCE SOLR 500MG DIMERCAPTOPROPANE-SULFONATE NA POWD CORLANOR TABS 5MG DEXTROSE SOLN 50% DANAZOL POWD DIMETHYL FUMARATE POWD CORLANOR TABS 7.5MG DEXTROSE-NACL SOLN 10-0.2% DANTROLENE SODIUM POWD DIMETHYL SULFONE POWD CORN OIL OIL DEXTROSE-NACL SOLN 10-0.45% HCL POWD DIMETHYL SULFOXIDE SOLN CORN STARCH POWD DEXTROSE-NACL SOLN 2.5-0.45% DAPSONE POWD DIMETHYLACETAMIDE LIQD ACETATE POWD DEXTROSE-NACL SOLN 5-0.225% DAYTRANA PTCH 10MG/9HR DIMETHYLAMINOETHANOL LIQD CORTISONE ACETATE TABS 25MG DEXTROSE-NACL SOLN 5-0.3% DAYTRANA PTCH 15MG/9HR DINITROCHLOROBENZENE CRYS CORVITA TABS 1.25MG DHEA MICRONIZED POWD DAYTRANA PTCH 20MG/9HR POWD COTTONSEED OIL OIL DIACOMIT CAPS 250MG DAYTRANA PTCH 30MG/9HR DIOXYBENZONE POWD COUMARIN POWD DIACOMIT CAPS 500MG DDAVP RHINAL TUBE SOLN 0.01% DIPHENHYDRAMINE HCL POWD CRANBERRY POWD DIACOMIT PACK 250MG POWD DIPHENIDOL HCL POWD CREATINE MONOHYDRATE POWD DIACOMIT PACK 500MG DELFLEX-LC/1.5% DEXTROSE SOLN 344MOSM/L DIPHENOXYLATE-ATROPINE LIQD 2.5-0.025MG/5ML CREATINE POWD DIALYVITE/ZINC TABS DELFLEX-LC/2.5% DEXTROSE SOLN 394MOSM/L DIPHENYLCYCLOPROPENONE POWD 98% CREATININE POWD DIAMINOPYRIDINE POWD DELFLEX-LC/4.25% DEXTROSE SOLN 483MOSM/L DIPYRIDAMOLE POWD CREON CPEP 12000UNIT DIAZEPAM GEL 10MG DEMECARIUM BROMIDE POWD DIPYRIDAMOLE SOLN 5MG/ML CREON CPEP 24000-76000UNIT DIAZEPAM GEL 2.5MG DEPO-ESTRADIOL OIL 5MG/ML DISULFIRAM POWD CREON CPEP 3000-9500UNIT DIAZEPAM GEL 20MG DEPO-PROVERA SUSP 400MG/ML DIVIGEL GEL 0.25MG/0.25GM CREON CPEP 36000UNIT DIAZEPAM POWD DESIPRAMINE HCL POWD DIVIGEL GEL 0.5MG/0.5GM CREON CPEP 6000UNIT DIAZEPAM SOLN 5MG/5ML DESLORATADINE TBDP 2.5MG DIVIGEL GEL 0.75MG/0.75GM CRESEMBA CAPS 186MG DIAZEPAM SOLN 5MG/ML DESLORATADINE TBDP 5MG DIVIGEL GEL 1MG/GM CRESEMBA SOLR 372MG DIAZOXIDE POWD DESONIDE POWD DL-PHENYLALANINE POWD CRESOL LIQD DIBUCAINE HCL POWD DESOXIMETASONE POWD DMAE BITARTRATE POWD CRIXIVAN CAPS 200MG DIBUTYL SQUARATE LIQD DESOXYCORTICOSTERONE ACETATE POWD DOCETAXEL CONC 200MG/10ML CROFAB SOLR DICHLORALPHENAZONE POWD DEXAMETHASONE ACETATE POWD DOCUSATE SODIUM POWD CROMOLYN SODIUM POWD DICHLOROACETIC ACID LIQD DEXAMETHASONE INTENSOL CONC 1MG/ML DOCUSATE SODIUM-SOD BENZOATE POWD 85-15% CROTON OIL OIL DICLOFENAC SODIUM POWD DEXAMETHASONE ISONICOTINATE POWD DOPAMINE HCL POWD CUPRIC SULFATE POWD DEXAMETHASONE POWD DICUMAROL POWD DOVER HYDROGEL FOLEY CATH 16FR MISC CURITY PACKING STRIP MISC DEXAMETHASONE SOD PHOS-NACL SOLN 10-0.9MG/50ML-% DICYCLOMINE HCL POWD DOVER HYDROGEL FOLEY CATH KIT KIT CURITY WOUND CLOSURE 1/8"X3" MISC DEXAMETHASONE SOD PHOSPHATE PF SOLN 10MG/ML DIETHANOLAMINE LIQD DOVER URINE LEG BAG/EXT TUBE MISC CYANOCOBALAMIN CRYS DEXAMETHASONE SODIUM PHOSPHATE POWD DIETHYL TOLUAMIDE LIQD DOXEPIN HCL CAPS 150MG CYANOCOBALAMIN POWD DEXAMETHASONE SODIUM PHOSPHATE SOLN 0.1% DIETHYLPROPION HCL ER TB24 75MG DOXEPIN HCL CREA 5% POWD DEXAMETHASONE SODIUM PHOSPHATE SOLN 10MG/ML DIETHYLPROPION HCL POWD DOXEPIN HCL POWD CYCLOBENZAPRINE HCL POWD DEXAMETHASONE SOLN 0.5MG/5ML POWD DOXYCYCLINE HYCLATE POWD CYCLOBENZAPRINE POWD DEXAMETHASONE TABS 1MG DIFLORASONE DIACETATE CREA 0.05% DOXYCYCLINE HYCLATE TABS 50MG CYCLOMETHICONE LIQD DEXAMETHASONE TABS 2MG DIGOXIN SOLN 0.05MG/ML DOXYLAMINE SUCCINATE POWD CYCLOPENTOLATE HCL POWD DEXCHLORPHENIRAMINE MALEATE SOLN 2MG/5ML DIHYDROERGOTAMINE MESYLATE CRYS DRITHO-CREME HP CREA 1% CYCLOPHOSPHAMIDE POWD DEXCOM G4 PLATINUM RECEIVER DEVI DIHYDROERGOTAMINE MESYLATE POWD DROPERIDOL POWD CYCLOSERINE POWD DEXCOM G4 PLATINUM TRANSMITTER MISC DIHYDROERGOTAMINE MESYLATE SOLN 4MG/ML DROXIA CAPS 200MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. DROXIA CAPS 300MG ENTRESTO TABS 97-103MG ETOMIDATE POWD FILTER NEEDLE MISC 18G X 1-1/2" DROXIA CAPS 400MG EOVIST SOLN 0.25MOL/L ETOPOSIDE POWD FINACEA FOAM 15% DUAVEE TABS 0.45-20MG EPHEDRINE HCL POWD EUCALYPTOL LIQD FINASTERIDE CRYS DUREZOL EMUL 0.05% EPHEDRINE SULFATE POWD EUCALYPTUS OIL OIL FINASTERIDE POWD DVORAH TABS 325-30-16MG EPHEDRINE SULFATE SOLN 50MG/ML EUGENOL SOLN FLAVOR BLEND SUSP DYANAVEL XR SUER 2.5MG/ML EPIDUO FORTE GEL 0.3-2.5% EVANS BLUE POWD FLAVOR PLUS LIQD DYCLONINE HCL CRYS EPINEPHRINE BASE POWD EXTRANEAL SOLN 7.5% FLAVOR SWEET SYRP DYCLONINE HCL POWD EPINEPHRINE BITARTRATE POWD FLECTOR PTCH 1.3% DYPHYLLINE POWD EPINEPHRINE HCL-DEXTROSE SOLN 2-5MG/250ML-% FLEXICHAMBER CHILD MASK/SMALL MISC EPINEPHRINE HCL-DEXTROSE SOLN 4-5MG/250ML-% F FLOVENT DISKUS AEPB 100MCG/BLIST FACE MASK EARLOOP-STYLE MISC EPINEPHRINE HCL-NACL SOLN 8-0.9MG/250ML-% FLOVENT DISKUS AEPB 250MCG/BLIST E FAMOTIDINE POWD EPINEPHRINE HCL-NACL SOSY 100-0.9MCG/10ML-% FLOVENT DISKUS AEPB 50MCG/BLIST E.E.S. 400 TABS 400MG FAMOTIDINE PREMIXED SOLN 20-0.9MG/50ML-% EPINEPHRINE HCL-NACL SOSY 1000-0.9MCG/10ML-% FLOVENT HFA AERO 110MCG/ACT EARPOPPER MIDDLE EAR INFLATION DEVI FARXIGA TABS 10MG EPINEPHRINE-DEXTROSE SOLN 2-5MG/250ML-% FLOVENT HFA AERO 220MCG/ACT EC-NAPROXEN TBEC 375MG FARXIGA TABS 5MG EPINEPHRINE-NACL SOLN 2-0.9MG/250ML-% FLOVENT HFA AERO 44MCG/ACT EC-NAPROXEN TBEC 500MG FD&C YELLOW #5 POWD EPINEPHRINE-NACL SOSY 1-0.9MG/10ML-% FLOXURIDINE POWD ECONAZOLE NITRATE POWD FDC BLUE 1 POWD EPROSARTAN MESYLATE TABS 600MG FLUCONAZOLE POWD EDARBI TABS 40MG FDC BLUE 2 POWD ERGOCALCIFEROL POWD FLUCYTOSINE POWD EDARBI TABS 80MG FDC GREEN #3 POWD MESYLATES POWD FLUDROCORTISONE ACETATE POWD EDARBYCLOR TABS 40-12.5MG FDC RED #3 POWD ERGOLOID MESYLATES TABS 1MG FLUNISOLIDE POWD EDARBYCLOR TABS 40-25MG FDC RED 40 POWD ERGOTAMINE TARTRATE POWD FLUNISOLIDE SOLN 25 MCG/ACT(0.025%) EDETATE ACID POWD FDC YELLOW 6 POWD ERYGEL GEL 2% FLUOCINOLONE ACETONIDE POWD EDETATE CALCIUM DISODIUM POWD FEM PH GEL 0.9-0.025% ERYTHROCIN LACTOBIONATE SOLR 500MG FLUOCINONIDE POWD EDETATE DISODIUM POWD FEMCAP DEVI 22MM ERYTHROCIN STEARATE TABS 250MG FLUORESCEIN POWD EDETATE SODIUM POWD FEMCAP DEVI 26MM ERYTHROMYCIN ESTOLATE POWD FLUORESCEIN SODIUM POWD EDROPHONIUM CHLORIDE POWD FEMCAP DEVI 30MM ERYTHROMYCIN ETHYLSUCCINATE POWD FLUORESCITE SOLN 10% ELETONE CREA FENOFIBRIC ACID TABS 105MG ERYTHROMYCIN POWD FLUOROURACIL POWD ELIQUIS TABS 2.5MG FENTANYL CITRATE (PF) SOCT 100MCG/2ML ESOMEPRAZOLE SODIUM SOLR 20MG FLUOROURACIL SOLN 2% ELIQUIS TABS 5MG FENTANYL CITRATE (PF) SOLN 100MCG/2ML ESPUMIL FOAM FLUOROURACIL SOLN 5% ELITE-OB TABS 50-1.25MG FENTANYL CITRATE (PF) SOLN 250MCG/5ML POWD FLUOXETINE HCL (PMDD) CAPS 10MG ELMIRON CAPS 100MG FENTANYL CITRATE (PF) SOLN 500MCG/10ML POWD FLUOXETINE HCL (PMDD) CAPS 20MG ELOCTATE SOLR 5000UNIT FENTANYL CITRATE (PF) SOLN 50MCG/ML ESTRADIOL MICRONIZED POWD FLUOXETINE HCL CPDR 90MG EMBEDA CPCR 100-4MG FENTANYL CITRATE POWD ESTRADIOL POWD FLUOXETINE HCL POWD EMBEDA CPCR 20-0.8MG FENTANYL CITRATE-NACL SOLN 1.25-0.9MG/250ML-% ESTRADIOL VALERATE CRYS FLUOXETINE HCL TABS 60MG EMBEDA CPCR 30-1.2MG FENTANYL CITRATE-NACL SOSY 10-0.9MCG/ML-% ESTRADIOL VALERATE POWD FLUPHENAZINE DECANOATE POWD EMBEDA CPCR 50-2MG FERRAPLUS 90 TABS 90-1MG ESTRING RING 2MG FLUPHENAZINE HCL CONC 5MG/ML EMBEDA CPCR 60-2.4MG FERRIC AMMONIUM CITRATE POWD CRYS FLUPHENAZINE HCL ELIX 2.5MG/5ML EMBEDA CPCR 80-3.2MG FERRIC CHLORIDE HEXAHYDRATE MISC ESTRONE POWD FLUPHENAZINE HCL SOLN 2.5MG/ML EMU OIL OIL FERRIC SUBSULFATE SOLN ETHAMOLIN SOLN 5% FLUPHENAZINE HCL TABS 10MG EMULSIFYING WAX WAX FERRIC SULFATE POWD SOLN FLUPHENAZINE HCL TABS 1MG EMULSION CONCENTRATE LIQD FERROUS FUMARATE POWD ETHINYL ESTRADIOL POWD FLUPHENAZINE HCL TABS 2.5MG EMULSION SB EMUL FERROUS GLUCONATE DIHYDRATE GRAN ETHOSUXIMIDE POWD FLUPHENAZINE HCL TABS 5MG EMVERM CHEW 100MG FERROUS GLUCONATE DIHYDRATE POWD ETHOXY DIGLYCOL LIQD FLURAZEPAM HCL CAPS 15MG ENALAPRIL MALEATE POWD FETZIMA CP24 120MG ETHYL ACETATE SOLN FLURAZEPAM HCL CAPS 30MG ENDOMETRIN INST 100MG FETZIMA CP24 20MG ETHYL CHLORIDE AERO FLURBIPROFEN POWD ENEMA BOTTLE MISC FETZIMA CP24 40MG ETHYL OLEATE LIQD FLURBIPROFEN SODIUM SOLN 0.03% ENSTILAR FOAM 0.005-0.064% FETZIMA CP24 80MG ETHYLENEDIAMINE LIQD 99% FLUTICASONE PROPIONATE POWD ENTRESTO TABS 24-26MG FEVERFEW POWD ETIDRONATE DISODIUM TABS 200MG FOLBEE PLUS CZ TABS 5MG ENTRESTO TABS 49-51MG FIASP PENFILL SOCT 100UNIT/ML ETIDRONATE DISODIUM TABS 400MG FOLIC ACID POWD FIASP SOLN 100UNIT/ML

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. FOLIC ACID SOLN 5MG/ML GENTAMICIN IN SALINE SOLN 0.8-0.9MG/ML-% GRASTEK SUBL 2800BAU HYDROCHLORIC ACID LIQD 10% FOLIVANE-F CAPS 125-1MG GENTAMICIN IN SALINE SOLN 1-0.9MG/ML-% GREEN TEA OIL FRAGRANCE OIL HYDROCHLORIC ACID LIQD 37% FOLIVANE-OB CAPS 130-92.4-1MG GENTAMICIN IN SALINE SOLN 1.6-0.9MG/ML-% GREEN TEA POWD HYDROCHLOROTHIAZIDE POWD FOLIVANE-PLUS CAPS GENTAMICIN IN SALINE SOLN 2-0.9MG/ML-% GREEN TEA POWD 95% HYDROCODONE BITARTRATE CRYS FOOD COLOR BLACK POWD GENTAMICIN SULFATE POWD GRISEOFULVIN MICROSIZE POWD HYDROCODONE BITARTRATE POWD FOOD COLOR BLUE LIQD GENTAMICIN SULFATE SOLN 10MG/ML SOLN HYDROCODONE-ACETAMINOPHEN SOLN 10-325MG/15ML FOOD COLOR BLUE POWD GENTIAN VIOLET POWD GUAIFENESIN POWD HYDROCORTISONE ACETATE POWD FOOD COLOR BROWN POWD GENVOYA TABS 150-150-200-10MG ACETATE POWD HYDROCORTISONE MICRONIZED POWD FOOD COLOR GREEN LIQD GERANIUM OIL OIL SULFATE POWD HYDROCORTISONE POWD FOOD COLOR GREEN POWD GERMALL PLUS LIQD GUANIDINE HCL TABS 125MG HYDROFLUORIC ACID LIQD 48% FOOD COLOR LIME GREEN POWD GINGER ROOT POWD GUANIDINEACETIC ACID POWD HYDROGEL GEL FOOD COLOR PINK LIQD GINSENG ROOT POWD GUAR GUM POWD SOLN 30% FOOD COLOR RED LIQD GLIPIZIDE POWD GYMNEMA SYLVESTRIS LEAF POWD HYDROMORPHONE HCL PF SOLN 10MG/ML FOOD COLOR VIOLET POWD GLUCAGEN DIAGNOSTIC SOLR 1MG HYDROMORPHONE HCL PF SOLN 2MG/ML FOOD COLOR WHITE LIQD GLUCAGEN HYPOKIT SOLR 1MG H HYDROMORPHONE HCL POWD FOOD COLOR YELLOW LIQD GLUCAGON EMERGENCY KIT 1MG H20 GEL BASE GEL HYDROMORPHONE HCL SOLN 4MG/ML FOOD COLOR YELLOW POWD GLUCONOLACTONE POWD HALOPERIDOL DECANOATE POWD HYDROMORPHONE HCL SUPP 3MG FORANE SOLN GLUCOSAMINE HCL POWD HALOPERIDOL POWD HYDROMORPHONE HCL-NACL SOSY 10-0.9MG/50ML-% FORMALDEHYDE SOLN 10% GLUCOSAMINE SULFATE NACL POWD HAWTHORN BERRY POWD HYDROMORPHONE HCL-NACL SOSY 15-0.9MG/30ML-% FORMALDEHYDE SOLN 37% GLUCOSAMINE SULFATE POTASSIUM POWD HEMABATE SOLN 250MCG/ML HYDROQUINONE POWD FUMARATE POWD GLUCOSAMINE SULFATE POWD HEMATOGEN FA CAPS 200-250-0.01-1MG HYDROXOCOBALAMIN ACETATE SOLN 1000MCG/ML FREAMINE HBC SOLN 6.9% IN WATER LIQD 50% HEMATOXYLIN POWD HYDROXOCOBALAMIN POWD FREAMINE III SOLN 10% GLUTARALDEHYDE SOLN 25% HEMETAB TABS 22-6-1-0.025MG HYDROXYAMPHETAMINE HBR POWD FRUCTOSE GRAN GLUTATHIONE-L POWD HEPARIN (PORCINE) IN NACL SOLN 1000-0.9UT/500ML-% HYDROXYCHLOROQUINE SULFATE POWD FRUCTOSE POWD GLYBURIDE POWD HEPARIN (PORCINE) IN NACL SOLN 2000-0.9UNIT/L-% HYDROXYETHYL CELLULOSE POWD FULLERS EARTH POWD GLYCERIN LIQD HEPARIN (PORCINE) IN NACL SOLN 25000-0.45UT/250ML-% HYDROXYETHYL METHACRYLATE POWD 96% FURAZOLIDONE POWD GLYCERIN SOLN HEPARIN (PORCINE) IN NACL SOLN 25000-0.45UT/500ML-% HYDROXYPROGESTERONE CAPROATE POWD FUROSEMIDE POWD GLYCERYL MONOSTEARATE FLAK HEPARIN LOCK FLUSH SOLN 1UNIT/ML HYDROXYPROPYL CELLULOSE POWD FUROSEMIDE SOLN 8MG/ML GLYCINE POWD HEPARIN SOD (PORCINE) IN D5W SOLN 100UNIT/ML HYDROXYPROPYL METHYLCELLULOSE POWD FYCOMPA SUSP 0.5MG/ML GLYCINE SOYA PROTEIN SOLN HEPARIN SOD (PORCINE) IN D5W SOLN 25000-5UT/500ML-% HYDROXYQUINOLINE SULFATE POWD FYCOMPA TABS 10MG GLYCOFUROL LIQD HEPARIN SOD (PORCINE) IN D5W SOLN 40-5UNIT/ML-% HYDROXYTRYPTOPHAN POWD FYCOMPA TABS 12MG GLYCOLIC ACID CRYS HEPARIN SODIUM POWD HYDROXYUREA POWD FYCOMPA TABS 2MG GLYCOLIC ACID GRAN HEPATAMINE SOLN 8% HYDROXYZINE HCL POWD FYCOMPA TABS 4MG GLYCOLIC ACID SOLN 70% HEPES POWD HYDROXYZINE HCL SOLN 25MG/ML FYCOMPA TABS 6MG GLYCOPHOS SOLN 1MMOLE/ML HEXTEND SOLN 6% HYDROXYZINE HCL SOLN 50MG/ML FYCOMPA TABS 8MG GLYCOPYRROLATE PF SOSY 0.4MG/2ML HIBERIX SOLR 10MCG HYDROXYZINE PAMOATE CAPS 100MG GLYCOPYRROLATE POWD HISTAMINE PHOSPHATE CRYS HYDROXYZINE PAMOATE POWD G GLYCOPYRROLATE TABS 1.5MG HISTATROL SOLN 0.275MG/ML HYOPHEN TABS 81.6MG GABAPENTIN POWD GLYCOSAMINOGLYCANS LIQD HOMATROPINE METHYLBROMIDE POWD HYOSCYAMINE SULFATE POWD GABLOFEN SOSY 10000MCG/20ML GLYCYRRHIZIC ACID POWD HONEY ALMOND FRAGRANCE LIQD HYPERRAB S/D SOLN 1500UNIT/10ML GALACTOSE POWD GLYTACTIN BETTERMILK 15 PACK HPR FOAM HYPERRAB S/D SOLN 300UNIT/2ML GALANTAMINE HYDROBROMIDE SOLN 4MG/ML GLYXAMBI TABS 10-5MG HRT BASE (MEN) GEL HYPERRAB SOLN 1500UNIT/5ML GAMMACORE DEVI GLYXAMBI TABS 25-5MG HRT BOTANICAL CREA HYPERRAB SOLN 300UNIT/ML GAMMACORE SAPPHIRE REFILL KIT MISC GOLD SODIUM THIOMALATE POWD HUMULIN R U-500 (CONCENTRATED) SOLN 500UNIT/ML HYPOCYN SOLN GANCICLOVIR SODIUM SOLN 500MG/10ML GRALISE STARTER MISC 300 & 600MG HUPERZINE SERRATE A POWD 1% HYZAAR TABS 50-12.5MG GARDENIA FRAGRANCE OIL GRALISE TABS 300MG HYALURONATE SODIUM POWD GELATIN POWD GRALISE TABS 600MG HYDRALAZINE HCL POWD I GEMFIBROZIL POWD GRAMICIDIN D POWD HYDRAZINE SULFATE CRYS IBUPROFEN POWD GENTAK OINT 0.3% GRAPE SEED OIL HYDROCHLORIC ACID LIQD IC GREEN SOLR 25MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. ICHTHAMMOL POWD IVERMECTIN POWD KETOTIFEN FUMARATE POWD LANOXIN PEDIATRIC SOLN 0.1MG/ML IDEBENONE POWD IXIARO SUSP KINETIN POWD LANSOPRAZOLE POWD IDOXURIDINE POWD KINEVAC SOLR 5MCG LANTUS SOLN 100UNIT/ML IMIDUREA POWD J KIWI FRAGRANCE LIQD LATUDA TABS 120MG IMIPRAMINE HCL POWD JANUMET TABS 50-1000MG KLOR-CON M15 TBCR 15MEQ LATUDA TABS 20MG IMIQUIMOD POWD JANUMET TABS 50-500MG KOJIC ACID POWD LATUDA TABS 40MG IMOVAX RABIES INJ 2.5UNIT/ML JANUMET XR TB24 100-1000MG KRISGEL 100 GEL LATUDA TABS 60MG IMPAVIDO CAPS 50MG JANUMET XR TB24 50-1000MG LATUDA TABS 80MG INDIGO CARMINE SOLN 8MG/ML JANUMET XR TB24 50-500MG L LAURETH-9 POLIDOCANOL LIQD INDOCYANINE GREEN POWD JANUVIA TABS 100MG L-ALANINE POWD LAURIC ACID POWD INDOLE-3-CARBINOL POWD JANUVIA TABS 25MG L-ARGININE POWD OIL INDOMETHACIN POWD JANUVIA TABS 50MG L-ASPARTIC ACID POWD LEAD ACETATE TRIHYDRATE POWD INFANRIX SUSP 25-58-10 JARDIANCE TABS 10MG L-CITRULLINE POWD LEAD TETROXIDE POWD 99% INFED SOLN 50MG/ML JARDIANCE TABS 25MG L-CYSTEINE CRYS LECITHIN GRAN INFUMORPH 200 SOLN 200 MG/20ML(10 MG/ML) JASMINE FRAGRANCE LIQD L-CYSTEINE HCL POWD LECITHIN GRAN INFUMORPH 500 SOLN 500 MG/20ML(25 MG/ML) JETREA SOLN 0.375MG/0.3ML L-CYSTEINE HCL SOLN 50MG/ML LECITHIN SOYA GRAN INFUSION SET MISC JOJOBA OIL OIL L-CYSTEINE POWD LETROZOLE POWD INFUVITE PEDIATRIC SOLN JUBLIA SOLN 10% L-CYSTINE POWD LEUCOVORIN CALCIUM POWD INOSITOL HEXANICOTINATE POWD JUNIPER TAR OIL L-GLUTAMIC ACID HCL POWD LEUKINE SOLR 250MCG INOSITOL POWD JUXTAPID CAPS 40MG L-GLUTAMIC ACID MONOSOD SALT POWD LEUPROLIDE ACETATE POWD INSUFLON MISC 25G X 0.71" JUXTAPID CAPS 60MG L-GLUTAMIC ACID POWD LEVAMISOLE HCL POWD INSYTE AUTOGUARD 24GX3/4" MISC L-GLUTAMINE POWD LEVEMIR SOLN 100UNIT/ML INTRALIPID EMUL 20% K L-HISTIDINE MONOHYDROCHLORIDE CRYS LEVETIRACETAM IN NACL SOLN 1000MG/100ML INVELTYS SUSP 1% K-PHOS TABS 500MG L-HISTIDINE MONOHYDROCHLORIDE POWD LEVETIRACETAM IN NACL SOLN 1500MG/100ML RESUBLIMED GRAN K-PHOS-NEUTRAL TABS 155-852-130MG L-ISOLEUCINE POWD LEVETIRACETAM IN NACL SOLN 500MG/100ML IODINE STRONG (LUGOL'S) SOLN K-TAB TBCR 8MEQ L-LEUCINE POWD LEVETIRACETAM POWD IODINE STRONG SOLN 5% KALYDECO TABS 150MG L-LYSINE HCL POWD LEVOCETIRIZINE DIHYDROCHLORIDE POWD IODOFORM POWD KANAMYCIN SULFATE POWD L-METHIONINE POWD LEVODOPA POWD IODOQUINOL POWD KANGAROO BALLOON 12FR/0.8CM KIT L-METHYLFOLATE TABS 15MG LEVOFLOXACIN HEMIHYDRATE POWD IONOSOL-MB IN D5W SOLN KANGAROO EPUMP SET 1000ML MISC L-METHYLFOLATE TABS 7.5MG LEVOFLOXACIN POWD IOPANOIC ACID POWD KANGAROO FEEDING TUBE 8FR/42" MISC L-METHYLFOLATE-B6-B12 TABS 3-35-2MG LEVOMEFOLATE CALCIUM POWD IPOL INJ KAOLIN POWD L-ORNITHINE HYDROCHLORIDE POWD LEVORPHANOL TARTRATE POWD IPRATROPIUM BROMIDE POWD KARAYA GUM GUM L-PROLINE POWD LEVOTHYROXINE SODIUM POWD ISOLYTE-P IN D5W SOLN KARAYA GUM POWD L-SELENOMETHIONINE POWD LEVOTHYROXINE SODIUM SOLR 100MCG ISOLYTE-S PH 7.4 SOLN KCL IN D5W LACTATED RINGERS SOLN 40MEQ/L L-SERINE POWD LEVOTHYROXINE SODIUM SOLR 200MCG ISOLYTE-S SOLN KCL IN DEXTROSE-NACL SOLN 20-5-0.225MEQ/L-%-% L- POWD LEVOTHYROXINE SODIUM SOLR 500MCG MUCATE POWD KCL IN DEXTROSE-NACL SOLN 20-5-0.33MEQ/L-%-% LABETALOL HCL POWD LEVSIN SOLN 0.5MG/ML ISONIAZID POWD KCL IN DEXTROSE-NACL SOLN 40-5-0.9MEQ/L-%-% LABETALOL HCL SOSY 20MG/4ML LEXISCAN SOLN 0.4MG/5ML ISONIAZID SOLN 100MG/ML KCL-LACTATED RINGERS-D5W SOLN 20MEQ/L LACTASE 5000 POWD LICORICE DEGLYCYRRHIZINATED POWD ISONIAZID SYRP 50MG/5ML KENDALL AMORPHOUS WOUND GEL LACTATED RINGERS SOLN LICORICE ROOT POWD ISOPROPAMIDE IODIDE POWD KETAMINE HCL POWD LACTATED RINGERS SOLN LIDOCAINE CRYS ISOPROPYL ALCOHOL SOLN 70% KETAMINE HCL SOSY 50MG/5ML SOLN LIDOCAINE HCL (CARDIAC) PF SOLN 100MG/5ML ISOPROPYL MYRISTATE SOLN KETAMINE HCL-SODIUM CHLORIDE SOSY 50-0.9MG/5ML-% LACTOSE ANHYDROUS POWD LIDOCAINE HCL (CARDIAC) PF SOSY 100MG/5ML ISOPROPYL PALMITATE LIQD KETOCONAZOLE POWD LACTOSE MONOHYDRATE POWD LIDOCAINE HCL (CARDIAC) PF SOSY 50MG/5ML ISOPROTERENOL HCL POWD KETOPROFEN CAPS 25MG LACTULOSE PACK 10GM LIDOCAINE HCL (CARDIAC) SOSY 50MG/5ML ISOSORBIDE DINITRATE TABS 30MG KETOPROFEN ER CP24 200MG LAMOTRIGINE POWD LIDOCAINE HCL (PF) SOLN 4% ISOSORBIDE POWD KETOPROFEN POWD LANOLIN ALCOHOL WAX LIDOCAINE HCL POWD ISOXSUPRINE HCL POWD KETOROLAC TROMETHAMINE POWD LANOLIN ANHYDROUS OINT LIDOCAINE HCL SOLN 4% ITRACONAZOLE POWD KETOROLAC TROMETHAMINE SOLN 60MG/2ML LANOLIN OIL LIDOCAINE HCL SOSY 10MG/ML

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. LIDOCAINE IN DEXTROSE SOLN 5-7.5% M MECLOFENAMATE SODIUM CAPS 50MG METHYLCELLULOSE POWD LIDOCAINE POWD MECLOFENAMATE SODIUM POWD METHYLCOBALAMIN POWD M-M-R II SOLR LIDOCAINE-HYDROCORTISONE ACE GEL 2.8-0.55% MECLOFENOXATE HCL POWD METHYLDOPA-HYDROCHLOROTHIAZIDE TABS 250-15MG M.V.I. ADULT INJ LIDOCAINE-PHENYLEPHRINE SOLN 1-1.5% MEDROXYPROGESTERONE ACE MICRO POWD METHYLDOPA-HYDROCHLOROTHIAZIDE TABS 250-25MG M.V.I. PEDIATRIC SOLR LIMONENE LIQD MEDROXYPROGESTERONE ACETATE POWD METHYLENE BLUE POWD MAGELLAN SYRINGE-SAFETY NEEDLE MISC 23G X 1"1 ML LINCOMYCIN HCL POWD MEDROXYPROGESTERONE MICRONIZED POWD METHYLENE BLUE SOLN 1% MAGNASWEET 110 LIQD LINDANE SHAM 1% MEFENAMIC ACID POWD METHYLPARABEN POWD MAGNASWEET 135 POWD LINEZOLID IN SODIUM CHLORIDE SOLN 600-0.9MG/300ML-% MEFLOQUINE HCL TABS 250MG METHYLPHENIDATE HCL ER TB24 18MG MAGNESIUM ALUMINUM SILICATE POWD LINOLEIC ACID LIQD MEGESTROL ACETATE POWD METHYLPHENIDATE HCL ER TB24 27MG MAGNESIUM CARBONATE HEAVY POWD LINSEED OIL OIL MELATONIN POWD METHYLPHENIDATE HCL ER TB24 36MG MAGNESIUM CHLORIDE CRYS LINZESS CAPS 145MCG MELOXICAM POWD METHYLPHENIDATE HCL ER TB24 54MG MAGNESIUM CHLORIDE POWD LINZESS CAPS 290MCG MENADIONE POWD METHYLPHENIDATE HCL POWD MAGNESIUM CHLORIDE SOLN 200MG/ML LINZESS CAPS 72MCG MENADIONE SODIUM BISULFITE CRYS METHYLPREDNISOLONE ACETATE POWD MAGNESIUM CITRATE POWD LIORESAL SOLN 0.05MG/ML MENOPUR SOLR 75UNIT METHYLPREDNISOLONE POWD MAGNESIUM GLUCONATE POWD LIORESAL SOLN 10MG/20ML MENTHOL CRYS CAPS 10MG MAGNESIUM GLYCINATE POWD LIORESAL SOLN 10MG/5ML MEPERIDINE HCL POWD METHYLTESTOSTERONE POWD MAGNESIUM HYDROXIDE POWD LIORESAL SOLN 40MG/20ML MEQUINOL POWD MALEATE POWD MAGNESIUM MALATE POWD LIOTHYRONINE POWD MERCAPTOPURINE MONOHYDRATE POWD METOCLOPRAMIDE HCL MONOHYDRATE POWD MAGNESIUM OXIDE POWD LIOTHYRONINE SODIUM POWD MERCAPTOPURINE POWD METOCLOPRAMIDE HCL POWD MAGNESIUM PHOSPHATE POWD LIPMAX SOLN MEROPENEM-SODIUM CHLORIDE SOLR 1GM/50ML METOPROLOL TARTRATE POWD MAGNESIUM STEARATE POWD LIPOFEN CAPS 150MG MEROPENEM-SODIUM CHLORIDE SOLR 500MG/50ML METOPROLOL TARTRATE SOCT 5MG/5ML MAGNESIUM SULFATE IN D5W SOLN 1-5GM/100ML-% LIPOFEN CAPS 50MG METACRESOL ACETATE LIQD METOPROLOL TARTRATE TABS 37.5MG MAGNESIUM SULFATE POWD LIPOSOMAL REGULAR CREA METAFOLBIC TABS 6-1-50-5MG METOPROLOL TARTRATE TABS 75MG MAGNESIUM SULFATE SOLN 20GM/500ML LISINOPRIL POWD METAPROTERENOL SULFATE POWD METOPROLOL-HYDROCHLOROTHIAZIDE TABS 100-50MG MAGNESIUM SULFATE SOLN 2GM/50ML LITHIUM CARBONATE CAPS 150MG METAPROTERENOL SULFATE SYRP 10MG/5ML METRONIDAZOLE BENZOATE POWD MAGNESIUM SULFATE SOLN 40GM/1000ML LITHIUM CARBONATE CAPS 600MG METAXALONE TABS 400MG METRONIDAZOLE IN NACL SOLN 500-0.74MG/100ML-% MAGNESIUM SULFATE SOLN 4GM/100ML LITHIUM CARBONATE POWD METFORMIN HCL POWD METRONIDAZOLE POWD MAGNESIUM SULFATE SOLN 4GM/50ML LITHIUM CITRATE TETRAHYDRATE POWD METFORMIN HCL SOLN 500MG/5ML METRONIDAZOLE SOLN 5MG/ML MALEIC ACID POWD LITHIUM SOLN 8MEQ/5ML METHACHOLINE CHLORIDE POWD MEXILETINE HCL CAPS 150MG MALIC ACID POWD LIVALO TABS 1MG METHADONE HCL POWD MEXILETINE HCL CAPS 200MG MALTODEXTRIN POWD LIVALO TABS 2MG METHADONE HCL SOLN 10MG/5ML MEXILETINE HCL CAPS 250MG MANDELIC ACID POWD LIVALO TABS 4MG METHADONE HCL SOLN 10MG/ML MEXILETINE HCL POWD MANGANESE CHLORIDE SOLN 0.1MG/ML LMD IN D5W SOLN 10-5% METHADONE HCL SOLN 5MG/5ML MIACALCIN SOLN 200UNIT/ML MANGANESE CHLORIDE TETRAHYD POWD LMD IN NACL SOLN 10-0.9% METHADOSE CONC 10MG/ML 3 SUPP 200MG MANGANESE GLUCONATE POWD LO LOESTRIN FE TABS 1 MG-10 MCG /10 MCG METHANESULFONIC ACID LIQD MICONAZOLE NITRATE POWD MANGANESE SULFATE POWD LOCUST BEAN GUM POWD SOLN MICONAZOLE POWD MANGANESE SULFATE SOLN 0.1MG/ML LOPERAMIDE HCL POWD MIDAZOLAM HCL-SODIUM CHLORIDE SOLN MANNITOL POWD METHAZOLAMIDE POWD LORATADINE POWD 100-0.9MG/100ML-% HCL TABS 25MG METHENAMINE MANDELATE POWD LORAZEPAM POWD MIDAZOLAM POWD MAPROTILINE HCL TABS 50MG METHENAMINE POWD LOTEMAX GEL 0.5% MIDAZOLAM-SODIUM CHLORIDE SOLN 50-0.9MG/50ML-% MAPROTILINE HCL TABS 75MG METHIMAZOLE POWD LOTEMAX OINT 0.5% MIGERGOT SUPP 2-100MG MARCAINE SOLN 0.75% METHITEST TABS 10MG LOTEMAX SM GEL 0.38% MILK THISTLE POWD MARQIBO SUSP 5MG/31ML METHOCARBAMOL POWD LUGOLS SOLN MILLIPRED DP TBPK 5MG (21) MATULANE CAPS 50MG METHOTREXATE POWD LUTEIN BEAD 5% MILLIPRED DP TBPK 5MG (48) MB HYDROGEL KIT METHOXSALEN POWD LUTEIN POWD 5% MILLIPRED TABS 5MG MEBENDAZOLE POWD METHOXYETHANOL LIQD LUXAMEND CREA MINERAL OIL HEAVY OIL MECAMYLAMINE HCL POWD METHSCOPOLAMINE BROMIDE POWD LUZU CREA 1% MINERAL OIL LIGHT OIL MECHLORETHAMINE HCL POWD METHSCOPOLAMINE NITRATE POWD LYSODREN TABS 500MG MINIMED 630G INSULIN PUMP KIT MECLIZINE HCL POWD METHYL SALICYLATE LIQD MINIMED 670G INSULIN PUMP DEVI MECLOFENAMATE SODIUM CAPS 100MG METHYLCELLULOSE GEL 1%

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. MINOCIN SOLR 100MG MONOJECT HYPODERMIC NEEDLE MISC 30G X 3/4" MORPHINE SULFATE SOLN 1MG/ML NADOLOL POWD MINOCYCLINE HCL POWD MONOJECT LIFESHIELD SYRINGE MISC 18G X 1"3 ML MORPHINE SULFATE SOLN 25MG/ML NAFCILLIN SODIUM IN DEXTROSE SOLN 1GM/50ML MINOXIDIL POWD MONOJECT MAGELLAN SYRINGE MISC 25G X 1"1 ML MORPHINE SULFATE SOLN 50MG/ML NAFCILLIN SODIUM IN DEXTROSE SOLN 2GM/100ML MIOSTAT SOLN 0.01% MONOJECT MAGELLAN SYRINGE MISC 25G X 5/8"1 ML MORPHINE SULFATE SUPP 10MG NAFCILLIN SODIUM SOLR 10GM MIRVASO GEL 0.33% MONOJECT MONODOSE ORAL MED SYR MISC MORPHINE SULFATE SUPP 20MG NAFCILLIN SODIUM SOLR 1GM MISOPROSTOL POWD 1% MONOJECT PHARMACY TRAY MISC 12 ML MORPHINE SULFATE SUPP 30MG NAFCILLIN SODIUM SOLR 2GM MITOMYCIN POWD MONOJECT PISTON SYRINGE MISC 140 ML MORPHINE SULFATE SUPP 5MG NALBUPHINE HCL POWD MITOTANE POWD MONOJECT SYRINGE ECC LUER MISC 35 ML MORPHINE SULFATE TABS 15MG NALIDIXIC ACID POWD MOLINDONE HCL TABS 10MG MONOJECT SYRINGE LUER-LOCK TIP MISC 60 ML MORPHINE SULFATE TABS 30MG NALOXONE HCL DIHYDRATE POWD MOLINDONE HCL TABS 25MG MONOJECT SYRINGE MISC 18G X 1"12 ML MORPHINE SULFATE-NACL SOLN 100-0.9MG/100ML-% NALOXONE HCL POWD MOLINDONE HCL TABS 5MG MONOJECT SYRINGE MISC 20G X 1-1/2"3 ML MORPHINE SULFATE-NACL SOLN 50-0.9MG/50ML-% NALOXONE HCL SOCT 0.4MG/ML MOLYBDENUM POWD MONOJECT SYRINGE MISC 20G X 1-1/2"6 ML MORPHINE SULFATE-NACL SOSY 0.5-0.9MG/ML-% NALOXONE HCL SOSY 2MG/2ML MOMETASONE FUROATE POWD MONOJECT SYRINGE MISC 20G X 1"3 ML MORPHINE SULFATE-NACL SOSY 30-0.9MG/30ML-% NALTREXONE HCL POWD POWD MONOJECT SYRINGE MISC 20G X 3/4"3 ML MORPHINE SULFATE-NACL SOSY 5-0.9MG/5ML-% NAMZARIC CP24 14-10MG MONOETHANOLAMINE LIQD MONOJECT SYRINGE MISC 21G X 1-1/2"3 ML MOVANTIK TABS 12.5MG NAMZARIC CP24 21-10MG MONOJECT ALLERGIST TRAY KIT 27G X 1/2"1 ML MONOJECT SYRINGE MISC 21G X 1-1/2"6 ML MOVANTIK TABS 25MG NAMZARIC CP24 28-10MG MONOJECT ALLERGIST TRAY KIT 28G X 1/2"0.5 ML MONOJECT SYRINGE MISC 21G X 1"3 ML MOXIFLOXACIN HCL SOLN 400MG/250ML NAMZARIC CP24 7-10MG MONOJECT ALLERGIST TRAY KIT 28G X 1/2"1 ML MONOJECT SYRINGE MISC 21G X 1"6 ML MOXISYLYTE HCL POWD DECANOATE OIL 200MG/ML MONOJECT FILTER NEEDLE MISC 20G X 1-1/2" MONOJECT SYRINGE MISC 22G X 1-1/2"3 ML MULTI-DRAW NEEDLE MISC 20G X 1" POWD MONOJECT HYPODERMIC NEEDLE MISC 14G X 1-1/2" MONOJECT SYRINGE MISC 22G X 1-1/2"6 ML MULTI-DRAW NEEDLE MISC 21G X 1" NAPROXEN POWD MONOJECT HYPODERMIC NEEDLE MISC 14G X 1" MONOJECT SYRINGE MISC 23G X 1"3 ML MULTI-DRAW NEEDLE MISC 22G X 1" NAPROXEN SODIUM POWD MONOJECT HYPODERMIC NEEDLE MISC 14G X 2" MONOJECT SYRINGE MISC 25G X 1-1/4"3 ML MULTIGEN FOLIC TABS 70-150-2-1MG NARCAN LIQD 4MG/0.1ML MONOJECT HYPODERMIC NEEDLE MISC 16G X 1-1/2" MONOJECT SYRINGE MISC 25G X 1"3 ML MULTIGEN PLUS TABS 50-101-1MG NASCOBAL SOLN 500MCG/0.1ML MONOJECT HYPODERMIC NEEDLE MISC 16G X 1" MONOJECT SYRINGE MISC 25G X 5/8"3 ML MULTIGEN TABS 70MG NATACYN SUSP 5% MONOJECT HYPODERMIC NEEDLE MISC 16G X 3/4" MONOJECT SYRINGE MISC 27G X 1-1/4"3 ML MULTITRACE-4 NEONATAL SOLN 100-25-1500MCG/ML NATAPRES LIQD MONOJECT HYPODERMIC NEEDLE MISC 16G X 5/8" MONOJECT SYRINGE MISC 6 ML MULTITRACE-4 PEDIATRIC SOLN 1-100-25-1000MCG/ML NATESTO GEL 5.5MG/ACT MONOJECT HYPODERMIC NEEDLE MISC 18G X 1-1/2" MONOJECT SYRINGE REGULAR TIP MISC 20 ML MULTITRACE-4 SOLN 4-400-100-1000MCG/ML NATURE-THROID TABS 113.75MG MONOJECT HYPODERMIC NEEDLE MISC 18G X 1" MONOJECT SYRINGE REGULAR TIP MISC 3 ML MULTITRACE-5 SOLN 4-400-100-20MCG/ML NATURE-THROID TABS 130MG MONOJECT HYPODERMIC NEEDLE MISC 19G X 1-1/2" MONOJECT TB SYRINGE MISC 1 ML MULTIVITAMIN/FLUORIDE CHEW 0.25MG NATURE-THROID TABS 146.25MG MONOJECT HYPODERMIC NEEDLE MISC 19G X 1" MONOJECT TB SYRINGE MISC 25G X 5/8"1 ML MULTIVITAMIN/FLUORIDE CHEW 0.5MG NATURE-THROID TABS 16.25MG MONOJECT HYPODERMIC NEEDLE MISC 20G X 1-1/2" MONOJECT TB SYRINGE MISC 26G X 3/8"1 ML MULTIVITAMIN/FLUORIDE CHEW 1MG NATURE-THROID TABS 162.5MG MONOJECT HYPODERMIC NEEDLE MISC 20G X 1" MONOJECT TB SYRINGE MISC 27G X 1/2"1 ML MUPIROCIN CALCIUM CREA 2% NATURE-THROID TABS 195MG MONOJECT HYPODERMIC NEEDLE MISC 21G X 1-1/2" MONOJECT TB SYRINGE MISC 28G X 1/2"0.5 ML MUPIROCIN POWD NATURE-THROID TABS 260MG MONOJECT HYPODERMIC NEEDLE MISC 21G X 1" MONOJECT TB SYRINGE MISC 28G X 1/2"1 ML MUSE PLLT 1000MCG NATURE-THROID TABS 32.5MG MONOJECT HYPODERMIC NEEDLE MISC 21G X 2" MONSELS FERRIC SUBSULFATE SOLN MUSE PLLT 125MCG NATURE-THROID TABS 325MG MONOJECT HYPODERMIC NEEDLE MISC 22G X 1-1/2" MONTELUKAST SODIUM POWD MUSE PLLT 250MCG NATURE-THROID TABS 48.75MG MONOJECT HYPODERMIC NEEDLE MISC 22G X 1" MORPHINE SULFATE (PF) SOLN 10MG/ML MUSE PLLT 500MCG NATURE-THROID TABS 65MG MONOJECT HYPODERMIC NEEDLE MISC 23G X 1" MORPHINE SULFATE (PF) SOLN 2MG/ML MYDAYIS CP24 12.5MG NATURE-THROID TABS 81.25MG MONOJECT HYPODERMIC NEEDLE MISC 23G X 3/4" MORPHINE SULFATE (PF) SOLN 4MG/ML MYDAYIS CP24 25MG NATURE-THROID TABS 97.5MG MONOJECT HYPODERMIC NEEDLE MISC 25G X 1-1/2" MORPHINE SULFATE (PF) SOLN 8MG/ML MYDAYIS CP24 37.5MG NEOMYCIN SULFATE POWD MONOJECT HYPODERMIC NEEDLE MISC 25G X 1-1/4" MORPHINE SULFATE ER BEADS CP24 120MG MYDAYIS CP24 50MG NEOMYCIN-POLYMYXIN B GU SOLN 40-200000 MONOJECT HYPODERMIC NEEDLE MISC 25G X 1" MORPHINE SULFATE ER BEADS CP24 30MG MYNATAL CAPS NEOMYCIN-POLYMYXIN-GRAMICIDIN SOLN 1.75-10000-.025 MONOJECT HYPODERMIC NEEDLE MISC 25G X 2" MORPHINE SULFATE ER BEADS CP24 45MG MYNATAL TABS 90-1MG NEOMYCIN-POLYMYXIN-HC SUSP 3.5-10000-1 MONOJECT HYPODERMIC NEEDLE MISC 25G X 5/8" MORPHINE SULFATE ER BEADS CP24 60MG MYNATAL-Z TABS NEOSTIGMINE METHYLSULFATE POWD MONOJECT HYPODERMIC NEEDLE MISC 26G X 1-1/2" MORPHINE SULFATE ER BEADS CP24 75MG MYRBETRIQ TB24 25MG NEOSTIGMINE METHYLSULFATE SOLN 10MG/10ML MONOJECT HYPODERMIC NEEDLE MISC 26G X 1/2" MORPHINE SULFATE ER BEADS CP24 90MG MYRBETRIQ TB24 50MG NEOSTIGMINE METHYLSULFATE SOLN 5MG/10ML MONOJECT HYPODERMIC NEEDLE MISC 27G X 1-1/2" MORPHINE SULFATE IN DEXTROSE SOLN 100-5MG/100ML-% NEOSTIGMINE METHYLSULFATE SOLN 5MG/5ML MONOJECT HYPODERMIC NEEDLE MISC 27G X 1-1/4" MORPHINE SULFATE POWD N NEOSTIGMINE METHYLSULFATE SOSY 5MG/5ML MONOJECT HYPODERMIC NEEDLE MISC 27G X 1/2" MORPHINE SULFATE SOLN 150MG/30ML NABUMETONE POWD NEOTUSS PLUS LIQD 7.5-4-30MG/5ML

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. NEPHRAMINE SOLN 5.4% NORTRIPTYLINE HCL SOLN 10MG/5ML OXYCODONE HCL POWD PEGANONE TABS 250MG NEUPRO PT24 1MG/24HR NOVOLOG MIX 70/30 SUSP (70-30) 100UNIT/ML OXYCODONE-ASPIRIN TABS 4.8355-325MG PENICILLAMINE POWD NEUPRO PT24 2MG/24HR NOVOLOG PENFILL SOCT 100UNIT/ML OXYCODONE-IBUPROFEN TABS 5-400MG PENICILLIN G POT IN DEXTROSE SOLN 20000UNIT/ML NEUPRO PT24 3MG/24HR NOVOLOG SOLN 100UNIT/ML OXYCONTIN T12A 10MG PENICILLIN G POT IN DEXTROSE SOLN 40000UNIT/ML NEUPRO PT24 4MG/24HR NOXAFIL SOLN 300MG/16.7ML OXYCONTIN T12A 15MG PENICILLIN G POT IN DEXTROSE SOLN 60000UNIT/ML NEUPRO PT24 6MG/24HR NOXAFIL SUSP 40MG/ML OXYCONTIN T12A 20MG PENICILLIN G PROCAINE SUSP 600000UNIT/ML NEUPRO PT24 8MG/24HR NUEDEXTA CAPS 20-10MG HCL POWD PENICILLIN G SODIUM SOLR 5000000UNIT NEUT SOLN 4% NUTRIVIT LIQD OXYMORPHONE HCL ER TB12 10MG PACLITAXEL CONC 150MG/25ML NEXTERONE SOLN 150-4.21MG/100ML-% NYLIDRIN HCL POWD OXYMORPHONE HCL ER TB12 15MG PENICILLIN V POTASSIUM SOLR 125MG/5ML NEXTERONE SOLN 360-4.14MG/200ML-% NYSTATIN POWD OXYMORPHONE HCL ER TB12 20MG PENICILLIN V POTASSIUM SOLR 250MG/5ML NIACIN (ANTIHYPERLIPIDEMIC) TABS 500MG OXYMORPHONE HCL ER TB12 30MG PENNYROYAL OIL OIL NIACIN POWD O OXYMORPHONE HCL ER TB12 40MG PENTACEL SUSR NIACINAMIDE POWD OBSTETRIX DHA MISC 29-1 & 387MG OXYMORPHONE HCL ER TB12 5MG PENTASA CPCR 250MG NICLOSAMIDE POWD OCTINOXATE LIQD OXYMORPHONE HCL ER TB12 7.5MG PENTASA CPCR 500MG ADENINE DINUCLEO POWD ODACTRA SUBL 12SQ-HDM OXYTETRACYCLINE HCL POWD PENTOBARBITAL SODIUM POWD NICOTINE POLACRILEX POWD OFLOXACIN TABS 300MG OXYTOCIN POWD PENTOSAN POLYSULFATE SODIUM POWD NICOTINE TARTRATE POWD OGESTREL TABS 0.5-50MG-MCG PENTOXIFYLLINE POWD NIFEDIPINE POWD OINTMENT BASE (EMULSIFYING) OINT P PENTYLENE GLYCOL LIQD NINLARO CAPS 2.3MG OLEABASE PLASTICIZED OINT PALMAROSA OIL PENTYLENETETRAZOLE CRYS NINLARO CAPS 3MG OLEIC ACID LIQD PALMITOYL PENTAPEPTIDE-3 GEL PEPPERMINT OIL OIL NINLARO CAPS 4MG OLIVE OIL OIL PANCREATIN POWD PEPSIN POWD NISOLDIPINE ER TB24 20MG OMEPRAZOLE POWD PANCURONIUM BROMIDE SOLN 1MG/ML PERFOROMIST NEBU 20MCG/2ML NISOLDIPINE ER TB24 25.5MG OMNIPAQUE SOLN 140MG/ML PANTHENOL POWD PERMETHRIN LIQD NISOLDIPINE ER TB24 30MG OMNIPAQUE SOLN 180MG/ML PAPAIN POWD PERPHENAZINE-AMITRIPTYLINE TABS 2-10MG NISOLDIPINE ER TB24 40MG OMNIPAQUE SOLN 240MG/ML HCL POWD PERPHENAZINE-AMITRIPTYLINE TABS 2-25MG NITRIC ACID LIQD OMNIPAQUE SOLN 300MG/ML PAPAVERINE HCL SOLN 30MG/ML PERPHENAZINE-AMITRIPTYLINE TABS 4-10MG NITRILE GLOVES/SIZE 10 MISC OMNIPAQUE SOLN 350MG/ML PARACHLOROPHENOL POWD PERPHENAZINE-AMITRIPTYLINE TABS 4-25MG NITRO-BID OINT 2% OMNIPOD 5 PACK MISC PERPHENAZINE-AMITRIPTYLINE TABS 4-50MG NITRO-TIME CPCR 9MG OMNIPOD STARTER KIT PAREGORIC TINC 2MG/5ML PERUVIAN BALSAM MISC NITROFURANTOIN ANHYDROUS POWD ONCASPAR SOLN 750UNIT/ML PARI SINUSTAR DELIVERY SYSTEM MISC PERUVIAN BALSAM POWD NITROFURANTOIN MACROCRYSTAL POWD ONDANSETRON HCL POWD PAROMOMYCIN SULFATE POWD PEUCEDANUM OSTRUTHIUM EXTRACT SOLN POWD ONEXTON GEL 1.2-3.75% PAZEO SOLN 0.7% PFIZERPEN SOLR 20000000UNIT NITROGLYCERIN ER CPCR 6.5MG ORBACTIV SOLR 400MG PCCA ACACIA SYRUP BASE SYRP PFIZERPEN SOLR 5000000UNIT NITROGLYCERIN IN D5W SOLN 100-5MCG/ML-% ORIGANUM OIL OIL PCCA COBASE #1 OINT PHENAZOPYRIDINE HCL POWD NITROGLYCERIN IN D5W SOLN 200-5MCG/ML-% ORPHENADRINE CITRATE POWD PCCA FIXED OIL BASE LIQD PHENDIMETRAZINE TARTRATE ER CP24 105MG NITROGLYCERIN IN D5W SOLN 400-5MCG/ML-% ORPHENGESIC FORTE TABS 770-60-50MG PCCA GELATIN BASE OINT PHENELZINE SULFATE POWD NITROGLYCERIN SOLN 5MG/ML OSMITROL SOLN 15% PCCA LIPOSOMIC BASE DRY CREA PHENINDIONE POWD NIZATIDINE SOLN 15MG/ML OTOVEL SOLN 0.3-0.025% PCCA LOXASPERSE BASE POWD PHENOBARBITAL POWD NOREPINEPHRINE-DEXTROSE SOLN 16-5MG/250ML-% OXANDROLONE POWD PCCA POLYGLYCOL TROCHE POWD PHENOBARBITAL SODIUM SOLN 130MG/ML NOREPINEPHRINE-DEXTROSE SOLN 4-5MG/250ML-% OXAZEPAM CAPS 10MG PCCA PRACAMAC BASE OIL PHENOBARBITAL SODIUM SOLN 65MG/ML NOREPINEPHRINE-DEXTROSE SOLN 8-5MG/250ML-% OXAZEPAM CAPS 15MG PCCA RAPID DISSOLVE TABLET POWD CRYS NOREPINEPHRINE-SODIUM CHLORIDE SOLN 16-0.9MG/250ML-% OXAZEPAM CAPS 30MG PCCA SORBITOL LOLLIPOP BASE FLAK PHENOL LIQD 89% NOREPINEPHRINE-SODIUM CHLORIDE SOLN 4-0.9MG/250ML-% OXERVATE SOLN 0.002% PEANUT OIL OIL PHENOLSULFONIC ACID LIQD NORETHINDRONE ACETATE POWD OXTELLAR XR TB24 150MG PECTIN POWD HCL POWD NORETHINDRONE POWD OXTELLAR XR TB24 300MG PEDIARIX SUSP PHENOXYETHANOL LIQD NORMOSOL-M IN D5W SOLN OXTELLAR XR TB24 600MG PEDVAX HIB SUSP 7.5MCG/0.5ML PHENTERMINE HCL POWD NORMOSOL-R IN D5W SOLN OXYBENZONE POWD PEG 400 MONOSTEARATE POWD MESYLATE POWD NORMOSOL-R PH 7.4 SOLN OXYBUTYNIN CHLORIDE POWD PEG OINTMENT BASE OINT PHENYLBUTAZONE POWD NORTRIPTYLINE HCL POWD PEG-40 CASTOR OIL OIL PHENYLEPHRINE HCL CRYS

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. PHENYLEPHRINE HCL POWD 400 LIQD POTASSIUM SULFATE POWD PRILOCAINE POWD PHENYLEPHRINE HCL SOLN 10MG/ML POLYETHYLENE GLYCOL 8000 GRAN POVIDONE-IODINE POWD PRIMAQUINE PHOSPHATE TABS 26.3MG PHENYLEPHRINE HCL-DEXTROSE SOLN 20-5MG/250ML-% POLYETHYLENE GLYCOL 8000 OINT PR NATAL 400 EC MISC 29-1-200 & 400MG (DR) PRIMEAIRE HOLDING CHAMBER DEVI PHENYLEPHRINE HCL-NACL SOLN 40-0.9MG/250ML-% POLYETHYLENE GLYCOL 8000 POWD PR NATAL 430 EC MISC 29-1-200 & 430MG (DR) PRIMIDONE POWD PHENYLEPHRINE HCL-NACL SOLN 50-0.9MG/250ML-% POLYETHYLENE GLYCOL POWD PR NATAL 430 MISC 29-1-200 & 430MG PRO DNA COLLECTION KIT 2% PHENYLEPHRINE HCL-NACL SOLN 80-0.9MG/250ML-% POLYHEXAMETHYLENE SOLN 20% PRAMOXINE HCL POWD PROCAINAMIDE HCL POWD PHENYLEPHRINE HCL-NACL SOSY 20-0.9MG/50ML-% POLYMYXIN B SULFATE POWD PRAZIQUANTEL POWD PROCAINE HCL CRYS PHENYLMERCURIC ACETATE POWD POLYOX WSR-301 POWD PREDNICARBATE CREA 0.1% PROCALAMINE SOLN 3% POWD POLYOXYL 40 STEARATE POWD PREDNICARBATE OINT 0.1% PROCENTRA SOLN 5MG/5ML PHENYTOIN POWD POLYPEG MISC PREDNISOLONE ACETATE POWD PROCHLORPERAZINE EDISYLATE POWD PHENYTOIN SODIUM POWD POLYSORBATE 20 SOLN PREDNISOLONE ACETATE SUSP 1% PROCHLORPERAZINE EDISYLATE SOLN 50MG/10ML PHOSLYRA SOLN 667MG/5ML POLYSORBATE 40 SOLN PREDNISOLONE ACETATE SUSP 1% PROCHLORPERAZINE MALEATE POWD PHOSPHATIDYLCHOLINE POWD POLYSORBATE 60 LIQD PREDNISOLONE ANHYDROUS POWD PROFILNINE SOLR 1000UNIT PHOSPHATIDYLSERINE POWD 40% POLYSORBATE 80 LIQD PREDNISOLONE SODIUM PHOSPHATE POWD PROFILNINE SOLR 1500UNIT PHOSPHOLINE IODIDE SOLR 0.125% POLYVINYL ALCOHOL POWD PREDNISOLONE SODIUM PHOSPHATE SOLN 1% PROFILNINE SOLR 500UNIT PHOSPHORIC ACID SOLN 85% POLYVINYLPYRROLIDONE K-30 POWD PREDNISOLONE SODIUM PHOSPHATE SOLN 25MG/5ML PROGESTERONE MICRONIZED POWD PHYSOSTIGMINE SALICYLATE SOLN 1MG/ML POTASH SULFURATED LUMP MISC PREDNISOLONE SYRP 15MG/5ML PROGESTERONE POWD PHYTIC ACID IN WATER LIQD 50% POTASSIUM ACETATE CRYS PREDNISONE INTENSOL CONC 5MG/ML PROLEUKIN SOLR 22000000UNIT PHYTONADIONE LIQD POTASSIUM ASPARTATE POWD PREDNISONE POWD PROMETHAZINE HCL POWD PICATO GEL 0.015% POTASSIUM BICARBONATE GRAN PREDNISONE SOLN 5MG/5ML PROMETHAZINE-DM SYRP 6.25-15MG/5ML PICATO GEL 0.05% POTASSIUM BICARBONATE POWD PREDNISONE TABS 50MG PROMETHAZINE-PHENYLEPH-CODEINE SYRP PILOCARPINE HCL POWD POTASSIUM BITARTRATE POWD MICRONIZED POWD 6.25-5-10MG/5ML PILOCARPINE NITRATE POWD POTASSIUM BROMIDE GRAN PREGNENOLONE POWD PROMETHAZINE-PHENYLEPHRINE SYRP 6.25-5MG/5ML PIMOZIDE TABS 1MG POTASSIUM BROMIDE POWD PREMARIN CREA 0.625MG/GM PROPANTHELINE BROMIDE POWD PIMOZIDE TABS 2MG POTASSIUM CHLORIDE ER TBCR 20MEQ PREMARIN SOLR 25MG PROPARACAINE HCL POWD PINE NEEDLE OIL OIL POTASSIUM CHLORIDE GRAN PREMARIN TABS 0.3MG PROPRANOLOL HCL POWD PINE OIL OIL POTASSIUM CHLORIDE IN DEXTROSE SOLN 40-5MEQ/L-% PREMARIN TABS 0.45MG PROPRANOLOL HCL SOLN 20MG/5ML PINE TAR LIQD POTASSIUM CHLORIDE POWD PREMARIN TABS 0.625MG PROPRANOLOL HCL SOLN 40MG/5ML PINEAPPLE EXTRACT LIQD POTASSIUM CHLORIDE SOLN 10MEQ/100ML PREMARIN TABS 0.9MG PROPRANOLOL-HCTZ TABS 40-25MG PINENE (L-ALPHA) POWD POTASSIUM CHLORIDE SOLN 10MEQ/50ML PREMARIN TABS 1.25MG PROPRANOLOL-HCTZ TABS 80-25MG PIPERINE POWD POTASSIUM CHLORIDE SOLN 20MEQ/100ML PREMPHASE TABS 0.625-5MG PROPYL GALLATE POWD PIROXICAM POWD POTASSIUM CHLORIDE SOLN 20MEQ/50ML PREMPRO TABS 0.3-1.5MG PROPYLENE GLYCOL LIQD PLACEBO #00 CAPS POTASSIUM CHLORIDE SOLN 40MEQ/100ML PREMPRO TABS 0.45-1.5MG PROPYLENE GLYCOL MONOSTEARATE BEAD PLASMA-LYTE 148 SOLN POTASSIUM CITRATE MONOHYDRATE GRAN PREMPRO TABS 0.625-2.5MG PROPYLPARABEN POWD PLASMA-LYTE A SOLN POTASSIUM CITRATE POWD PREMPRO TABS 0.625-5MG PROPYLTHIOURACIL POWD PLASMANATE SOLN 5% POTASSIUM GLUCONATE ANHYDROUS POWD PRENA 1 TRUE MISC 30-1.4 & 300MG PROQUAD SUSR PLO GEL - MEDIFLO KIT POTASSIUM HYDROXIDE PLLT PRENA1 CHEW 1.4MG PROSOL SOLN 20% PLO TRANSDERMAL CREA POTASSIUM HYDROXIDE SOLN 45% PRENA1 PEARL CPCR 30-1.4-200MG PROTAMINE SULFATE POWD PLO20 FLOWABLE GEL POTASSIUM IODIDE GRAN PRENAISSANCE CAPS 29-1.25-325MG PROTAMINE SULFATE SOLN 10MG/ML PLURONIC F127 GEL 20% POTASSIUM IODIDE POWD PRENAISSANCE PLUS CAPS 28-1-250MG PROTOPAM CHLORIDE SOLR 1GM PLURONIC F127 GEL 30% POTASSIUM METABISULFITE POWD PRENATAL-U CAPS 106.5-1MG PROVENGE SUSP PLURONIC L64 LIQD POTASSIUM NITRATE POWD PREPOPIK PACK 10-3.5-12MG-GM-GM PROVENT SR SLEEP APNEA THERAPY MISC PNV-DHA+DOCUSATE CAPS 27-1.25-300MG POTASSIUM PERCHLORATE CRYS PRETAB TABS 29-1MG PSEUDOEPH-CHLORPHEN-HYDROCOD SOLN 60-4-5MG/5ML PNV-SELECT TABS 27-0.6-0.4MG GRAN PREZISTA TABS 800MG HCL POWD PODOPHYLLUM RESIN POWD POTASSIUM PHOSPHATE DIBASIC GRAN PRIALT SOLN 100MCG/ML PSYLLIUM HUSK POWD POLOXAMER 407 POWD POTASSIUM PHOSPHATE MONOBASIC CRYS PRIALT SOLN 500MCG/20ML PULMICORT FLEXHALER AEPB 180MCG/ACT POLYETHYLENE GLYCOL 300 LIQD POTASSIUM PHOSPHATES SOLN 150MMOLE/50ML PRIALT SOLN 500MCG/5ML PULMICORT FLEXHALER AEPB 90MCG/ACT POLYETHYLENE GLYCOL 3350 GRAN POTASSIUM PHOSPHATES SOLN 15MMOLE/5ML PRIFTIN TABS 150MG PUMICE (FLOUR) POWD POLYETHYLENE GLYCOL 3350 POWD POTASSIUM SORBATE POWD PRILOCAINE HCL POWD PURIFIED WATER LIQD

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. PYRANTEL PAMOATE POWD RENACIDIN SOLN SALSALATE POWD SOLN 10% PYRIDOSTIGMINE BROMIDE POWD REOPRO SOLN 2MG/ML SALVAX FOAM 6% SILVER NITRATE SOLN 25% PYRIDOXAL-5-PHOSPHATE POWD REPAGLINIDE-METFORMIN HCL TABS 1-500MG SAMI THE SEAL NEBULIZER SYSTEM KIT SILVER NITRATE SOLN 50% PYRIDOXINE HCL POWD REPAGLINIDE-METFORMIN HCL TABS 2-500MG SANTYL OINT 250UNIT/GM SILVER PROTEIN MILD POWD PYRIDOXINE HCL SOLN 100MG/ML REPATHA PUSHTRONEX SYSTEM SOCT 420MG/3.5ML SAPHRIS SUBL 10MG SILVER SULFADIAZINE POWD PYRILAMINE MALEATE CRYS RESCRIPTOR TABS 200MG SAPHRIS SUBL 2.5MG SIMETHICONE LIQD PYRILAMINE MALEATE POWD RESECTISOL SOLN 5% SAPHRIS SUBL 5MG SIMPLE SYRUP SYRP PYRIMETHAMINE POWD RESERPINE POWD SASSAFRAS OIL OIL SIMVASTATIN POWD PYROGALLOL CRYS CRYS SAVELLA TABS 100MG SIROLIMUS POWD PYRUVIC ACID LIQD RESORCINOL POWD SAVELLA TABS 12.5MG SODIUM 4-AMINOSALICYLATE POWD PYRUVIC ACID POWD RESTASIS MULTIDOSE EMUL 0.05% SAVELLA TABS 25MG SODIUM ACETATE CRYS RESTORE SILVER PADS 2"X2" SAVELLA TABS 50MG SODIUM ACETATE SOLN 2MEQ/ML Q RESTORE SILVER DRESSING PADS 4"X4" SAVELLA TITRATION PACK MISC 12.5 & 25 & 50MG SODIUM ACETATE TRIHYDRATE POWD QUADRACEL SUSP RHOPRESSA SOLN 0.02% SAW PALMETTO BERRY POWD SODIUM ALGINATE POWD QUATERNIUM-15 POWD RIBASPHERE RIBAPAK (1000 PACK) TBPK 400 & 600MG SCARLET RED POWD SODIUM ASCORBATE GRAN QUDEXY XR CS24 25MG RIBASPHERE RIBAPAK (1200 PACK) TBPK 600MG SCOPOLAMINE HBR POWD SODIUM ASCORBATE POWD DIHYDRATE POWD RIBASPHERE RIBAPAK (600 PACK) TBPK 200 & 400MG SE-NATAL 19 TABS 29-1MG SODIUM ASCORBYL PHOS DIHYDRATE POWD QUILLIVANT XR SUSR 25MG/5ML RIBASPHERE RIBAPAK (800 PACK) TBPK 400MG SECONAL CAPS 100MG SODIUM BENZOATE POWD QUINACRINE HCL POWD RIBASPHERE TABS 400MG SECRETIN-MANNITOL POWD 1-99% SODIUM BICARBONATE POWD QUINIDINE SULFATE DIHYDRATE CRYS RIBASPHERE TABS 600MG SELEGILINE HCL POWD SODIUM BICARBONATE SOLN 7.5% QUINIDINE SULFATE TABS 200MG RIBOFLAVIN 5-PHOSPHATE SODIUM POWD SELEGILINE HCL TABS 5MG SODIUM BICARBONATE SOLN 8.4% QUINIDINE SULFATE TABS 300MG RIBOFLAVIN POWD SELENIUM SOLN 40MCG/ML SODIUM BICARBONATE-DEXTROSE SOLN 150MEQ/L QUININE HCL DIHYDRATE CRYS RIBOSE (D) POWD SELENIUM SULFIDE POWD SODIUM BISULFITE GRAN QUININE SULFATE DIHYDRATE POWD RIDAURA CAPS 3MG SELENIUM YEAST POWD SODIUM BORATE DECAHYDRATE POWD QUINIZARIN GREEN SS POWD RIFAMPIN POWD SENSORCAINE-MPF/EPINEPHRINE SOLN 0.75-1:200000% SODIUM BROMIDE GRAN QVAR REDIHALER AERB 40MCG/ACT RISPERIDONE TBDP 0.25MG SEREVENT DISKUS AEPB 50MCG/DOSE SODIUM BUTYRATE POWD QVAR REDIHALER AERB 80MCG/ACT ROPIVACAINE HCL POWD SERMORELIN ACETATE POWD SODIUM CACODYLATE POWD ROSE BENGAL B POWD SEROSTIM SOLR 4MG SODIUM CAPRATE POWD R ROSE OIL OIL SEROSTIM SOLR 5MG SODIUM CARBONATE ANHYDROUS POWD R-GENE 10 SOLN 10% ROSEMARY OIL OIL SEROSTIM SOLR 6MG SODIUM CHLORIDE GRAN RABAVERT SUSR ROSIN MISC SEROTONIN HCL POWD SODIUM CHLORIDE POWD RACEPINEPHRINE HCL POWD ROTATEQ SOLN SERTRALINE HCL POWD SODIUM CHLORITE FLAK RAGWITEK SUBL 12AMB A 1-U RUTIN POWD SESAME OIL OIL SODIUM CITRATE ANHYDROUS POWD RANITIDINE HCL POWD RYBELSUS TABS 14MG SEVELAMER HCL TABS 400MG SODIUM CITRATE CRYS RANITIDINE HCL SOLN 1000MG/40ML RYBELSUS TABS 3MG SHARK CARTILAGE POWD SODIUM CITRATE DIHYDRATE POWD RAPIVAB SOLN 200MG/20ML RYBELSUS TABS 7MG SHARPS CONTAINER MISC SODIUM DEOXYCHOLATE POWD RAPPORT VTD KIT RYTARY CPCR 23.75-95MG SHEA BUTTER MISC SODIUM DICHLOROACETATE POWD RASPBERRY CONCENTRATE CONC RYTARY CPCR 36.25-145MG SHOWER FRESH FRAGRANCE LIQD SODIUM FLUORIDE POWD RASPBERRY SYRUP SYRP RYTARY CPCR 48.75-195MG SIBERIAN GINSENG POWD SODIUM GLUCONATE POWD RAUWOLFIA SERPENTINA POWD RYTARY CPCR 61.25-245MG SIDESTREAM NEBULIZER-DISP MISC PLLT RECEDO GEL SIGNIFOR SOLN 0.3MG/ML SODIUM HYDROXIDE SOLN 10% RECOMBIVAX HB SUSP 40MCG/ML S SIGNIFOR SOLN 0.6MG/ML SODIUM IODIDE GRAN RECTIV OINT 0.4% SACCHARIN POWD SIGNIFOR SOLN 0.9MG/ML SODIUM LACTATE SOLN 5MEQ/ML RED YEAST RICE POWD SAFFLOWER OIL OIL SILDENAFIL CITRATE POWD SODIUM LACTATE SOLN 60% REGONOL SOLN 10MG/2ML SAGE LEAF POWD SILICA GEL SODIUM LAURETH SULFATE LIQD REGRANEX GEL 0.01% SALICYLIC ACID CRYS SILICON DIOXIDE POWD SODIUM LAURYL SULFATE POWD RELISTOR SOLN 12MG/0.6ML SALICYLIC ACID LOTN 6% SILVASORB GEL SODIUM METABISULFITE GRAN RELISTOR SOLN 8MG/0.4ML SALICYLIC ACID POWD SILVER NITRATE CRYS SODIUM METABISULFITE POWD RELISTOR TABS 150MG SALICYLIC ACID SOLN 26% SILVER NITRATE SOLN 0.5% SODIUM NITRATE POWD

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. SODIUM NITRITE GRAN SSS 10-5 FOAM 10-5% SULINDAC POWD TEFLARO SOLR 600MG SODIUM OLEATE POWD ST JOHNS WORT POWD SUMATRIPTAN POWD TEKTURNA HCT TABS 150-12.5MG SODIUM PERBORATE POWD STAMARIL SUSR SUMATRIPTAN SUCCINATE POWD TEKTURNA HCT TABS 150-25MG SODIUM PHENYLBUTYRATE POWD POWD SUMATRIPTAN SUCCINATE SOSY 6MG/0.5ML TEKTURNA HCT TABS 300-12.5MG SODIUM PHOSPHATE DIBASIC CRYS STEARIC ACID FLAK SUPEROXIDE DISMUTASE POWD TEKTURNA HCT TABS 300-25MG SODIUM PHOSPHATE DIBASIC GRAN STEARIC ACID POWD SUPPORT LIQD TELFA AMD ISLAND DRESSING PADS 4"X5" SODIUM PHOSPHATE DIBASIC POWD STEARYL ALCOHOL FLAK SUPREP BOWEL PREP KIT SOLN 17.5-3.13-1.6GM/177ML TENCON TABS 50-325MG SODIUM PHOSPHATE MONOBASIC POWD STEARYL ALCOHOL POWD SURE-T INFUSION SET 23" MISC TERBINAFINE HCL POWD SODIUM PHOSPHATES SOLN 15MMOLE/5ML STERILE DILUENT FOR FLOLAN SOLN SYLATRON KIT 200MCG TERBUTALINE SULFATE POWD SODIUM PIDOLATE LIQD STEVIA EXTRACT POWD SYLATRON KIT 300MCG TERCONAZOLE CREA 0.8% SODIUM PROPIONATE POWD STEVIOL POWD 95% SYLATRON KIT 600MCG TERPIN HYDRATE POWD SODIUM SACCHARIN GRAN STEVIOSIDE EXTR 15% SYLVANT SOLR 100MG TESTOSTERONE CYPIONATE POWD SODIUM SACCHARIN POWD STIOLTO RESPIMAT AERS 2.5-2.5MCG/ACT SYLVANT SOLR 400MG TESTOSTERONE CYPIONATE SOLN 100MG/ML SODIUM SALICYLATE POWD STREPTOMYCIN SULFATE POWD SYMBICORT AERO 160-4.5MCG/ACT TESTOSTERONE CYPIONATE SOLN 200MG/ML SODIUM SELENITE POWD STREPTOMYCIN SULFATE SOLR 1GM SYMBICORT AERO 80-4.5MCG/ACT TESTOSTERONE ENANTHATE POWD SODIUM STEARATE POWD CHLORIDE CRYS SYMPROIC TABS 0.2MG TESTOSTERONE ENANTHATE SOLN 200MG/ML SODIUM STEARYL FUMARATE POWD STRONTIUM NITRATE CRYS SYNERCID SOLR 150-350MG TESTOSTERONE GEL 12.5 MG/ACT(1%) SODIUM SUCCINATE POWD SUCCIMER DMSA POWD SYNJARDY TABS 12.5-1000MG TESTOSTERONE GEL 25 MG/2.5GM(1%) SODIUM SULFACETAMIDE WASH LIQD 10% SUCCINIC ACID CRYS SYNJARDY TABS 12.5-500MG TESTOSTERONE GEL 50 MG/5GM(1%) SODIUM SULFATE POWD SUCCINYLCHOLINE CHLORIDE POWD SYNJARDY TABS 5-1000MG TESTOSTERONE GEL 50 MG/5GM(1%) SODIUM SULFITE POWD SUCRALFATE POWD SYNJARDY TABS 5-500MG TESTOSTERONE MICRONIZED CRYS SODIUM TETRADECYL SULFATE POWD SUCRALFATE SUSP 1GM/10ML SYNJARDY XR TB24 10-1000MG TESTOSTERONE MICRONIZED POWD SODIUM TETRADECYL SULFATE SOLN 27% SUCROSE OCTAACETATE CRYS SYNJARDY XR TB24 12.5-1000MG TESTOSTERONE POWD SODIUM THIOSULFATE POWD SUCROSE POWD SYNJARDY XR TB24 25-1000MG POWD SODIUM THIOSULFATE SOLN 25% SUFENTANIL CITRATE POWD SYNJARDY XR TB24 5-1000MG TESTOSTERONE PROPIONATE SOLN 100MG/ML SODIUM VALPROATE POWD SUFENTANIL CITRATE SOLN 100MCG/2ML SYRSPEND SF PH4 SUSR TETRACAINE HCL POWD SOLOSEC PACK 2GM SUFENTANIL CITRATE SOLN 250MCG/5ML TETRACAINE HCL SOLN 1% SOLU-CORTEF SOLR 1000MG SUFENTANIL CITRATE SOLN 50MCG/ML T TETRACAINE POWD SOLU-CORTEF SOLR 100MG SULFACETAMIDE POWD T.E.D. THIGH LENGTH/S-REGULAR MISC TETRACYCLINE HCL POWD SOLU-CORTEF SOLR 250MG SULFACETAMIDE SODIUM OINT 10% TACROLIMUS POWD TETRAHYDROBIOPTERIN DIHCL POWD SOLU-CORTEF SOLR 500MG SULFACETAMIDE SODIUM POWD TALC POWD TETRAHYDROZOLINE HCL POWD SORBIC ACID POWD SULFACETAMIDE SODIUM-SULFUR LOTN 10-5% TAMOXIFEN CITRATE POWD THEANINE POWD SORBITAN MONOLAURATE LIQD SULFACETAMIDE SODIUM-SULFUR SUSP 10-5% TANGERINE FLAVOR OIL THEOBROMINE POWD SORBITAN MONOOLEATE LIQD SULFACETAMIDE-PREDNISOLONE SOLN 10-0.23% TANNIC ACID POWD THEOCHRON TB12 100MG SORBITOL POWD SULFACETAMIDE-SULFUR IN UREA EMUL 10-5% TARON FORTE CAPS THEOCHRON TB12 200MG SORBITOL SOLN 70% SULFADIAZINE POWD TARON-C DHA CAPS 53.5-38-1MG THEOPHYLLINE ANHYDROUS POWD SOTALOL HCL SOLN 150MG/10ML SULFADIAZINE SODIUM POWD TARON-PREX CAPS 30-1.2-265MG THEOPHYLLINE ER TB12 450MG SOTRADECOL SOLN 1% SULFADIAZINE TABS 500MG TARTARIC ACID POWD THEOPHYLLINE IN D5W SOLN 0.8-5MG/ML-% SOTYLIZE SOLN 5MG/ML SULFAMERAZINE POWD TAURINE LIQD THIABENDAZOLE POWD SOYBEAN OIL OIL SULFAMETHOXAZOLE POWD TAURINE POWD THIAMINE HCL POWD SPG SUPPOSI-BASE PLLT SULFAMYLON CREA 85MG/GM TAYTULLA CAPS 1-20MG-MCG(24) THIOGUANINE POWD SPINOSAD SUSP 0.9% SULFANILAMIDE POWD TAZICEF SOLR 1GM THIORIDAZINE HCL POWD SPIRIVA HANDIHALER CAPS 18MCG SULFAPYRIDINE POWD TAZICEF SOLR 2GM THIOTEPA POWD SPIRIVA RESPIMAT AERS 1.25MCG/ACT SULFASALAZINE POWD TAZORAC CREA 0.05% THREONINE POWD SPIRIVA RESPIMAT AERS 2.5MCG/ACT SULFATHIAZOLE POWD TAZORAC GEL 0.05% THYMOL CRYS SPIRONOLACTONE POWD SULFISOXIZOLE CRYS TAZORAC GEL 0.1% THYMOL IODIDE POWD SQUALANE LIQD SULFOSALICYLIC ACID DIHYDRATE POWD TB SYRINGE 1 ML MISC THYROID (PORCINE) POWD SQUALANE OIL SULFUR POWD TEA TREE OIL OIL THYROID POWD SQUARIC ACID POWD SULFURIC ACID SOLN TEFLARO SOLR 400MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. TIGECYCLINE SOLR 50MG TRICITRASOL CONC 46.7% V VIDEX SOLR 2GM TIMOLOL MALEATE POWD POWD VALACYCLOVIR HCL POWD VIIBRYD STARTER PACK KIT 10 & 20MG TIMOLOL MALEATE SOLG 0.25% VIIBRYD TABS 10MG TRIETHANOLAMINE LAURYL SULFATE LIQD VALERIAN ROOT POWD TIMOLOL MALEATE SOLG 0.5% TRIFLURIDINE SOLN 1% VALINE POWD VIIBRYD TABS 20MG TIMOLOL MALEATE TABS 10MG POWD VANADIUM POWD VIIBRYD TABS 40MG TIMOLOL MALEATE TABS 20MG TRIMEPRAZINE TARTRATE POWD VANADYL SULFATE HYDRATE CRYS VIMPAT SOLN 10MG/ML TINIDAZOLE POWD TRIMETHOBENZAMIDE HCL POWD VANCOMYCIN HCL IN DEXTROSE SOLN 1-5GM/100ML-% VIMPAT SOLN 200MG/20ML TITANIUM DIOXIDE LIQD 30% TRIMETHOPRIM POWD VANCOMYCIN HCL IN DEXTROSE SOLN 1-5GM/200ML-% VIMPAT TABS 100MG TITANIUM DIOXIDE POWD TRIMO-SAN GEL 0.025-0.01% VANCOMYCIN HCL IN DEXTROSE SOLN 1-5GM/250ML-% VIMPAT TABS 150MG TIZANIDINE HCL POWD TRINATAL RX 1 TABS 60-1MG VANCOMYCIN HCL IN DEXTROSE SOLN 1.25-5GM/250ML-% VIMPAT TABS 200MG TL G-FOL OS TABS 500-1.1MG TRINTELLIX TABS 10MG VANCOMYCIN HCL IN DEXTROSE SOLN 1.5-5GM/250ML-% VIMPAT TABS 50MG TOBRADEX OINT 0.3-0.1% TRINTELLIX TABS 20MG VANCOMYCIN HCL IN DEXTROSE SOLN 1.5-5GM/500ML-% VINATE M TABS 27-1MG TOBRADEX ST SUSP 0.3-0.05% TRINTELLIX TABS 5MG VANCOMYCIN HCL IN DEXTROSE SOLN 1.75-5GM/500ML-% VINPOCETINE POWD TOBRAMYCIN POWD TRIOXSALEN POWD VANCOMYCIN HCL IN DEXTROSE SOLN 500-5MG/100ML-% VIOKACE TABS 10440UNIT TOBRAMYCIN SULFATE POWD TRIPELENNAMINE HCL POWD VANCOMYCIN HCL IN DEXTROSE SOLN 750-5MG/150ML-% VIOKACE TABS 20880UNIT TOBRAMYCIN SULFATE SOLN 10MG/ML TRIPROLIDINE HCL CRYS VANCOMYCIN HCL IN NACL SOLN 1-0.9GM/200ML-% VITAMIN A ACETATE BEAD TOBRAMYCIN SULFATE SOLN 2GM/50ML TRITON X-100 LIQD VANCOMYCIN HCL IN NACL SOLN 1-0.9GM/250ML-% VITAMIN A PALMITATE LIQD HCL POWD TRIVEEN-DUO DHA MISC 29-1-200 & 400MG VANCOMYCIN HCL IN NACL SOLN 1.25-0.9GM/250ML-% VITAMIN D3 LIQD 1000000UNIT/GM TOLBUTAMIDE TABS 500MG TROKENDI XR CP24 100MG VANCOMYCIN HCL IN NACL SOLN 1.5-0.9GM/250ML-% VITAMIN D3 POWD TOLMETIN SODIUM CAPS 400MG TROKENDI XR CP24 200MG VANCOMYCIN HCL IN NACL SOLN 1.5-0.9GM/300ML-% VITAMIN D3 POWD 100000UNIT/GM TOLMETIN SODIUM TABS 200MG TROKENDI XR CP24 25MG VANCOMYCIN HCL IN NACL SOLN 1.5-0.9GM/500ML-% VITAMIN E ACETATE LIQD TOLMETIN SODIUM TABS 600MG TROKENDI XR CP24 50MG VANCOMYCIN HCL IN NACL SOLN 1.75-0.9GM/250ML-% VITAMIN E POWD 500UNIT/GM TOLNAFTATE POWD TROLAMINE LIQD VANCOMYCIN HCL IN NACL SOLN 1.75-0.9GM/500ML-% VITAMIN E SUCCINATE POWD TOLUIDINE BLUE O POWD TROMETHAMINE POWD VANCOMYCIN HCL IN NACL SOLN 2-0.9GM/500ML-% VITRAKVI CAPS 100MG TOOMEY SYRINGE MISC 70 ML TROPHAMINE SOLN 6% VANCOMYCIN HCL IN NACL SOLN 500-0.9MG/100ML-% VITRAKVI CAPS 25MG TOPIRAMATE POWD TROPICAMIDE POWD VANCOMYCIN HCL IN NACL SOLN 750-0.9MG/150ML-% VIVOTIF CPDR TOVIAZ TB24 4MG TROPICAMIDE-CYCLOPENTOLATE-PE SOLN 1-1-2.5% VANCOMYCIN HCL POWD VOL-NATE TABS 28-1MG TOVIAZ TB24 8MG TRUZONE PEAK FLOW METER DEVI VANCOMYCIN HCL SOLR 250MG/5ML VOL-PLUS TABS 27-1MG TRACE ELEMENTS 4/PEDIATRIC SOLN 1-100-30-500MCG/ML TRYPAN BLUE POWD VANCOMYCIN HCL SOLR 750MG VOL-TAB RX TABS 29-1MG TRAGACANTH POWD TRYPSIN POWD VARIVAX INJ 1350PFU/0.5ML VOLUVEN SOLN 6-0.9% TRAMADOL HCL POWD TRYPTOPHAN POWD VARIZIG SOLN 125UNIT/1.2ML VORICONAZOLE POWD TRANDOLAPRIL-VERAPAMIL HCL ER TBCR 1-240MG TURMERIC POWD VARUBI TABS 90MG VYVANSE CAPS 10MG TRANEXAMIC ACID POWD TURPENTINE SPRT VASCEPA CAPS 0.5GM VYVANSE CAPS 20MG TRANILAST POWD TYPHIM VI SOLN 25MCG/0.5ML VASCEPA CAPS 1GM VYVANSE CAPS 30MG TRAZODONE HCL POWD VAXCHORA SUSR VYVANSE CAPS 40MG TRELEGY ELLIPTA AEPB 100-62.5-25MCG/INH U VELPHORO CHEW 500MG VYVANSE CAPS 50MG TRESIBA SOLN 100UNIT/ML UBIQUINOL POWD VERAPAMIL HCL ER CP24 100MG VYVANSE CAPS 60MG TRETINOIN (EMOLLIENT) CREA 0.05% UBIQUINOL POWD 30% VERAPAMIL HCL ER CP24 300MG VYVANSE CAPS 70MG TRETINOIN POWD UCERIS FOAM 2MG/ACT VERAPAMIL HCL ER CP24 360MG VYVANSE CHEW 10MG TRI-CHLOR LIQD 80% ULTIMATECARE ONE CAPS 27-1MG VERAPAMIL HCL POWD VYVANSE CHEW 20MG TRIACETIN LIQD UNDECYLENIC ACID LIQD VERSABASE CREA VYVANSE CHEW 30MG TRIAMCINOLONE ACETONIDE POWD UNIVERSAL WATER GEL VERSABASE FOAM VYVANSE CHEW 40MG TRIAMCINOLONE DIACETATE POWD UREA CREA 45% VERSABASE GEL VYVANSE CHEW 50MG TRIAMCINOLONE POWD UREA POWD VERSABASE LOTN VYVANSE CHEW 60MG TRIAMTERENE POWD URIDINE POWD VERSABASE SHAM TRIANEX OINT 0.05% URIMAR-T TABS 120MG VIBATIV SOLR 750MG W TRICHLORMETHIAZIDE POWD UROGESIC-BLUE TABS 81.6MG VIBERZI TABS 100MG WARFARIN SODIUM POWD TRICHLOROACETIC ACID CRYS URSODIOL POWD VIBERZI TABS 75MG WHEAT GERM OIL OIL TRICHLOROACETIC ACID POWD VIDARABINE POWD WHEY PROTEIN ISOLATE POWD

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. WHITE PETROLATUM OINT ZINC CITRATE POWD # ALDARA CREA 5% ALFENTANIL HCL SOLN 1000MCG/2ML WITCH HAZEL EXTR ZINC GLUCONATE POWD 7T GUMMY ES CHEW 500MG WITEPSOL PLLT ZINC MONOMETHIONINE POWD ALFENTANIL HCL SOLN 2500MCG/5ML WITEPSOL WAX ZINC OXIDE POWD A ALINIA TABS 500MG ALLEVYN AG ADHESIVE PADS 12.5X12.5CM ZINC PICOLINATE POWD ACCOLATE TABS 10MG ALLEVYN AG ADHESIVE PADS 7.5X7.5CM X ZINC SULFATE GRAN ACCU-CHEK RAPID-D INFUSION SET MISC ALREX SUSP 0.2% XANTHAN GUM POWD ZINC SULFATE POWD ACCUPRIL TABS 10MG ALTACE CAPS 1.25MG XARELTO TABS 10MG ZINC SULFATE SOLN 1MG/ML ACCUPRIL TABS 20MG ALTACE CAPS 10MG XARELTO TABS 15MG ZINC SULFATE SOLN 5MG/ML ACCUPRIL TABS 40MG ALTACE CAPS 2.5MG XARELTO TABS 2.5MG ZINC TRACE METAL SOLN 1MG/ML ACCUPRIL TABS 5MG ALTACE CAPS 5MG XARELTO TABS 20MG ZINC UNDECYLENATE POWD ACCURETIC TABS 10-12.5MG ALTRENO LOTN 0.05% XEROFORM PETROLAT GAUZE 1"X8" MISC ZOMIG SOLN 2.5MG ACCURETIC TABS 20-12.5MG AMARYL TABS 1MG XEROFORM PETROLAT PATCH 2"X2" PADS ZOMIG SOLN 5MG ACCURETIC TABS 20-25MG AMARYL TABS 2MG XIFAXAN TABS 200MG ZOSYN SOLN 2-0.25GM/50ML ACETADOTE SOLN 200MG/ML AMARYL TABS 4MG XIFAXAN TABS 550MG ZOSYN SOLN 3-0.375GM/50ML ACTICOAT ABSORBENT MISC 3/4"X12" AMINO ACID SOLN 5% XIGDUO XR TB24 10-1000MG ZOSYN SOLN 4-0.5GM/100ML ACTICOAT FLEX 3 SHEE 4"X8" AMIODARONE HCL IN DEXTROSE SOLN 150-5MG/100ML-% XIGDUO XR TB24 10-500MG ZTLIDO PTCH 1.8% ACTICOAT FLEX 7 SHEE 1"X24" AMITIZA CAPS 24MCG XIGDUO XR TB24 2.5-1000MG ZUBSOLV SUBL 0.7-0.18MG ACTICOAT FLEX 7 SHEE 4"X5" AMITIZA CAPS 8MCG XIGDUO XR TB24 5-1000MG ZUBSOLV SUBL 1.4-0.36MG ACTICOAT SHEE 5"X5" ANALPRAM HC CREA 2.5-1% XIGDUO XR TB24 5-500MG ZUBSOLV SUBL 11.4-2.9MG ACTICOAT SITE DISK ANALPRAM-HC CREA 1-1% XIIDRA SOLN 5% ZUBSOLV SUBL 2.9-0.71MG ACTIVELLA TABS 0.5-0.1MG ANALPRAM-HC LOTN 2.5-1% XULANE PTWK 150-35MCG/24HR ZUBSOLV SUBL 5.7-1.4MG ADALAT CC TB24 60MG ANGELIQ TABS 0.25-0.5MG XYLITOL POWD ZUBSOLV SUBL 8.6-2.1MG Tier 4 ADALAT CC TB24 90MG ANGELIQ TABS 0.5-1MG HCL POWD ZYKADIA CAPS 150MG Tier 4: Non- ADDERALL XR CP24 10MG ANTABUSE TABS 250MG ZYLET SUSP 0.5-0.3% Preferred Brand: ADDERALL XR CP24 15MG ANTARA CAPS 30MG Y $100 - ADDERALL XR CP24 20MG APPLE FLAVOR LIQD YEAST EXTRACT LIQD ADDERALL XR CP24 25MG After deductible APRISO CP24 0.375GM YELLOW PETROLATUM OINT ADDERALL XR CP24 30MG APTENSIO XR CP24 10MG YF-VAX INJ ADDERALL XR CP24 5MG APTENSIO XR CP24 15MG YLANG-YLANG OIL FRAGRANCE OIL ADIPEX-P CAPS 37.5MG APTENSIO XR CP24 20MG HCL POWD ADRENALIN SOLN 0.1% APTENSIO XR CP24 30MG ADZENYS ER SUER 1.25MG/ML APTENSIO XR CP24 40MG AEROECLIPSE II NEBULIZER MISC Z APTENSIO XR CP24 50MG ZATEAN-PN DHA CAPS 27-0.6-0.4-300MG AFREZZA POWD 4 & 8 & 12UNIT APTENSIO XR CP24 60MG ZATEAN-PN PLUS CAPS 28-0.6-0.4-340MG AFREZZA POWD 4UNIT ARCAPTA NEOHALER CAPS 75MCG ZEAXANTHIN POWD AFREZZA POWD 8UNIT ARGATROBAN IN SODIUM CHLORIDE SOLN 125-0.9MG/125ML-% ZELAPAR TBDP 1.25MG AFREZZA POWD 90 X 4 UNIT &90X8 UNIT ARGATROBAN IN SODIUM CHLORIDE SOLN 50-0.9MG/50ML-% ZENPEP CPEP 10000-32000UNIT AFREZZA POWD 90 X 8 UNIT &90X12 UNIT ARGATROBAN SOLN 50MG/50ML ZENPEP CPEP 15000-47000UNIT AGGRASTAT SOLN 12.5-0.9MG/250ML-% ARGYLE TRACHEOSTOMY CARE TRAY KIT ZENPEP CPEP 20000-63000UNIT AGGRASTAT SOLN 5-0.9MG/100ML-% ARIDOL KIT ZENPEP CPEP 25000-79000UNIT AGRYLIN CAPS 0.5MG ARNICA LIQD ZENPEP CPEP 3000-14000UNIT AKTIPAK PACK 5-3% ARTHROTEC TBEC 50-0.2MG ZENPEP CPEP 40000-126000UNIT ALBUMINEX SOLN 25% ARTHROTEC TBEC 75-0.2MG ZENPEP CPEP 5000-24000UNIT ALCAINE SOLN 0.5% ARYMO ER TBEA 15MG ZERBAXA SOLR 1.5 (1-0.5)GM ALDACTAZIDE TABS 25-25MG ASCOR SOLN 25000MG/50ML ZEVALIN Y-90 KIT 3.2MG/2ML ALDACTAZIDE TABS 50-50MG ASTEPRO SOLN 0.15% ZINC ACETATE CRYS ALDACTONE TABS 100MG ATABEX EC TBEC 29-1MG ZINC ACETATE POWD ALDACTONE TABS 25MG ATRAPRO CP KIT ZINC CHLORIDE GRAN ALDACTONE TABS 50MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. ALDARA CREA 5% ATRAPRO DERMAL SPRAY LIQD BUPIVACAINE HCL-NACL SOLN 0.1-0.9% CHLOROPHYLLIN SODIUM COPPER POWD CROTAMITON LIQD ALFENTANIL HCL SOLN 1000MCG/2ML ATROPINE SULFATE SOSY 1.2MG/3ML BUPIVACAINE HCL-NACL SOLN 0.125-0.9% CHONDROITIN SULFATE SOLN 0.25% CUPRIC CHLORIDE DIHYDRATE CRYS ALFENTANIL HCL SOLN 2500MCG/5ML ATROPINE SULFATE SOSY 1MG/2.5ML BUPIVACAINE HCL-NACL SOLN 0.125-0.9% CHROMIUM K SULFATE DODECAHYD CRYS CURITY NACL DRESSING 6"X6-3/4" PADS ALINIA TABS 500MG ATROPINE SULFATE SOSY 2MG/5ML BUPIVACAINE HCL-NACL SOSY 0.25-0.9% CHROMIUM POLYNICOTINATE POWD CUSTOM POLYGLYCOL TROCHE BASE WAX ALLEVYN AG ADHESIVE PADS 12.5X12.5CM AUGMENTIN ES-600 SUSR 600-42.9MG/5ML BUTISOL SODIUM TABS 30MG CIPRO SUSR 500 MG/5ML(10%) CUTIVATE LOTN 0.05% ALLEVYN AG ADHESIVE PADS 7.5X7.5CM AURYXIA TABS 1 GM210 MG(FE) CIPRO TABS 250MG CYCLOGYL SOLN 0.5% ALREX SUSP 0.2% AVANDIA TABS 2MG C CIPRO TABS 500MG CYCLOSET TABS 0.8MG ALTACE CAPS 1.25MG AVANDIA TABS 4MG CALAN SR TBCR 120MG CITRANATAL 90 DHA MISC 90-1 & 300MG CYCLOSPORINE IN KLARITY EMUL 0.1% ALTACE CAPS 10MG AVAR LS CLEANSER LIQD 10-2% CALAN SR TBCR 180MG CITRANATAL ASSURE MISC 35-1 & 300MG CYTOTEC TABS 200MCG ALTACE CAPS 2.5MG AVAR LS FOAM 10-2% CALAN SR TBCR 240MG CITRANATAL DHA MISC 27-1 & 250MG ALTACE CAPS 5MG AVAR LS PADS 10-2% CALAN TABS 120MG CITRANATAL HARMONY CAPS 27-1-260MG D ALTRENO LOTN 0.05% AVAR PADS 9.5-5% CALCIUM AMINO ACID CHELATE GRAN 30% CLARINEX TABS 5MG DANTRIUM CAPS 25MG AMARYL TABS 1MG AVENOVA SOLN 0.01% CALCIUM GLUCONATE SOSY 1000MG/10ML CLARINEX-D 12 HOUR TB12 2.5-120MG DANTRIUM CAPS 50MG AMARYL TABS 2MG AYGESTIN TABS 5MG CALCIUM GLYCEROPHOSPHATE POWD CLEOCIN CAPS 75MG DAYPRO TABS 600MG AMARYL TABS 4MG AZULFIDINE TABS 500MG CANADIAN BALSAM LIQD CLEOCIN CREA 2% DDAVP TABS 0.1MG AMINO ACID SOLN 5% CAPEX SHAM 0.01% CLEOCIN PHOSPHATE SOLN 300MG/2ML DEBACTEROL SOLN 30-50% AMIODARONE HCL IN DEXTROSE SOLN 150-5MG/100ML-% B CARAFATE TABS 1GM CLEOCIN PHOSPHATE SOLN 600MG/4ML DELFLEX-SM/2.5% DEXTROSE SOLN 398MOSM/L AMITIZA CAPS 24MCG BACLOFEN TABS 5MG CARBATROL CP12 100MG CLEOCIN PHOSPHATE SOLN 900MG/6ML DEMEROL SOLN 100MG/2ML AMITIZA CAPS 8MCG BACMIN TABS CARBATROL CP12 200MG CLEOCIN-T GEL 1% DEMEROL SOLN 100MG/ML ANALPRAM HC CREA 2.5-1% BACTRIM DS TABS 800-160MG CARBATROL CP12 300MG CLEOCIN-T LOTN 1% DEMEROL SOLN 25MG/0.5ML ANALPRAM-HC CREA 1-1% BACTRIM TABS 400-80MG CARBOCAINE SOLN 1% CLEVIPREX EMUL 50MG/100ML DEMEROL SOLN 25MG/ML ANALPRAM-HC LOTN 2.5-1% BALCOLTRA TABS 0.1-20MG-MCG(21) CARDENE IV SOLN 40-0.83MG/200ML-% CLINDAMYCIN PHOSPHATE IN NACL SOLN 300-0.9MG/50ML-% DEMEROL SOLN 50MG/ML ANGELIQ TABS 0.25-0.5MG BANZEL SUSP 40MG/ML CARDIOTEK RX TABS CLOBEX LOTN 0.05% DEMEROL SOLN 75MG/1.5ML ANGELIQ TABS 0.5-1MG BASE A POLYETHYLENE GLYCOL POWD CARDIZEM LA TB24 120MG CLOBEX SHAM 0.05% DEMEROL SOLN 75MG/ML ANTABUSE TABS 250MG BD SAF-T-INTIMA 22G X 0.75" KIT CARDIZEM LA TB24 240MG CLOBEX SPRAY LIQD 0.05% DEPACON SOLN 100MG/ML ANTARA CAPS 30MG BD SAFETY-LOK SET MISC CARDIZEM LA TB24 300MG CLODERM CREA 0.1% DEPAKENE CAPS 250MG APPLE FLAVOR LIQD BD SYRINGE SLIP TIP MISC 20 ML CARDIZEM LA TB24 360MG CLOZARIL TABS 25MG DEPAKOTE ER TB24 500MG APRISO CP24 0.375GM BENZAMYCIN GEL 5-3% CARDIZEM LA TB24 420MG COLAZAL CAPS 750MG DEPAKOTE TBEC 250MG APTENSIO XR CP24 10MG BEPREVE SOLN 1.5% CARDIZEM TABS 30MG COLCRYS TABS 0.6MG DEPAKOTE TBEC 500MG APTENSIO XR CP24 15MG BETADINE OPHTHALMIC PREP SOLN 5% CARDURA TABS 1MG COLESTID GRAN 5GM DEPLIN 15 CAPS 15-90.314MG APTENSIO XR CP24 20MG BEYAZ TABS 3-0.02-0.451MG CARDURA TABS 2MG COLESTID PACK 5GM DEPLIN 7.5 CAPS 7.5-90.314MG APTENSIO XR CP24 30MG BIJUVA CAPS 1-100MG CARDURA TABS 4MG COMTAN TABS 200MG DEPO-MEDROL SUSP 20MG/ML APTENSIO XR CP24 40MG BIOGUARD ISLAND DRESSINGS PADS 4"X10" CARDURA TABS 8MG CONCEPT DHA CAPS 53.5-38-1MG DEPO-TESTOSTERONE SOLN 100MG/ML APTENSIO XR CP24 50MG BIOGUARD ISLAND DRESSINGS PADS 4"X14" CARDURA XL TB24 4MG CONCEPT OB CAPS 130-92.4-1MG DERMOTIC OIL 0.01% APTENSIO XR CP24 60MG BIOGUARD ISLAND DRESSINGS PADS 4"X5" CARDURA XL TB24 8MG CORDRAN CREA 0.025% DESOWEN CREA 0.05% ARCAPTA NEOHALER CAPS 75MCG BIONECT CREA 0.2% CARNITOR SOLN 200MG/ML CORGARD TABS 20MG DESVENLAFAXINE ER TB24 100MG ARGATROBAN IN SODIUM CHLORIDE SOLN 125-0.9MG/125ML-% BIONECT FOAM 0.2% CARNITOR TABS 330MG CORGARD TABS 40MG DESVENLAFAXINE ER TB24 50MG ARGATROBAN IN SODIUM CHLORIDE SOLN 50-0.9MG/50ML-% BIONECT GEL 0.2% CAROSPIR SUSP 25MG/5ML CORGARD TABS 80MG DEXAMETHASONE (LA) SUSP 16MG/ML ARGATROBAN SOLN 50MG/50ML BLOXIVERZ SOLN 10MG/10ML CATAPRES TABS 0.1MG CORTANE-B LOTN 10-10-1MG/ML DEXAMETHASONE (LA) SUSP 8MG/ML ARGYLE TRACHEOSTOMY CARE TRAY KIT BLOXIVERZ SOLN 5MG/10ML CATAPRES TABS 0.3MG CORTEF TABS 10MG DEXAMETHASONE ACE & SOD PHOS SUSP 8-4MG/ML ARIDOL KIT BREVIBLOC IN NACL SOLN 2000MG/100ML CEFAZOLIN SODIUM SOSY 1GM/10ML CORTEF TABS 20MG DEXAMETHASONE SOD PHOS-BUPIV SOSY 0.01-0.375% ARNICA LIQD BREVIBLOC IN NACL SOLN 2500MG/250ML CEFTAZIDIME POWD CORTEF TABS 5MG DEXMEDETOMIDINE HCL-DEXTROSE SOLN 200MCG/50ML-5% ARTHROTEC TBEC 50-0.2MG BREVIBLOC SOLN 100MG/10ML CELESTONE SOLUSPAN SUSP 6 (3-3)MG/ML COSOPT PF SOLN 2-0.5% DEXONTO 0.4% SOLN 20MG/5ML ARTHROTEC TBEC 75-0.2MG BRIMONIDINE-DORZOLAMIDE SOLN 0.15-2% CEQUA SOLN 0.09% COUMADIN TABS 10MG DEXTRAN 40000 POWD ARYMO ER TBEA 15MG BRIVIACT SOLN 10MG/ML CEREBYX SOLN 500MG PE/10ML COUMADIN TABS 1MG DIANEAL LOW CALCIUM/1.5% DEX SOLN 344MOSM/L ASCOR SOLN 25000MG/50ML BROVANA NEBU 15MCG/2ML CEREFOLIN NAC TABS 6-90.314-2-600MG COUMADIN TABS 2MG DIANEAL PD-2/1.5% DEXTROSE SOLN 346MOSM/L ASTEPRO SOLN 0.15% BRYHALI LOTN 0.01% CEREFOLIN TABS 6-1-50-5MG COUMADIN TABS 3MG DIANEAL PD-2/2.5% DEXTROSE SOLN 396MOSM/L ATABEX EC TBEC 29-1MG BUFFERED LIDOCAINE SOSY 0.9-8.4% CETACAINE AERO 2-2-14% COUMADIN TABS 5MG DIANEAL PD-2/4.25% DEXTROSE SOLN 485MOSM/L ATRAPRO CP KIT BUPIVACAINE HCL-NACL SOLN 0.0625-0.9% CETACAINE LIQD 2-2-14% COUMADIN TABS 7.5MG DICLEGIS TBEC 10-10MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. DICLOFONO GEL 1.6% ENBRACE HR CAPS FENTANYL-BUPIVACAINE-NACL SOLN 0.5-0.125-0.9MG/250ML-% GLYRX-PF SOLN 0.2MG/ML DICLOPR KIT 1 & 10-30% ENLYTE CAPS FENTANYL-BUPIVACAINE-NACL SOLN 1-0.1-0.9MG/250ML-% GLYRX-PF SOLN 0.4MG/2ML DIFFERIN LOTN 0.1% EPHEDRINE SULFATE (PRESSORS) SOSY 25MG/5ML FERRALET 90 TABS 90-1MG GLYSET TABS 100MG DIFLUCAN SUSR 10MG/ML EPHEDRINE SULFATE (PRESSORS) SOSY 50MG/5ML FERRLECIT SOLN 12.5MG/ML GLYSET TABS 25MG DIFLUNISAL POWD EPHEDRINE SULFATE SOSY 25MG/5ML FERROUS BISGLYCINATE CHELATE POWD GLYSET TABS 50MG DILANTIN INFATABS CHEW 50MG EPHEDRINE SULFATE-NACL SOSY 100-0.9MG/10ML-% FEXMID TABS 7.5MG GLYTACTIN RESTORE LITE 10PE PACK DILANTIN SUSP 125MG/5ML EPHEDRINE SULFATE-NACL SOSY 25-0.9MG/5ML-% FINACEA GEL 15% GONITRO PACK 400MCG DILAUDID LIQD 1MG/ML EPICYN SOLN FIORICET CAPS 50-300-40MG GORDOFILM SOLN 16.7-16.7% DILAUDID TABS 2MG EPIFOAM FOAM 1-1% FIORINAL CAPS 50-325-40MG GREEN EMUL DILAUDID TABS 8MG EPINEPHRINE HCL-DEXTROSE SOLN 1-5MG/250ML-% FIRST-LANSOPRAZOLE SUSP 3MG/ML GUM BASE (GELATIN) GEL DILTIAZEM HCL-DEXTROSE SOLN 125-5MG/125ML-% EPINEPHRINE HCL-NACL SOLN 8-0.9MG/250ML-% FIRST- BLM SUSP DIPROLENE OINT 0.05% EQUETRO CP12 200MG FIRST-OMEPRAZOLE SUSP 2MG/ML H DITROPAN XL TB24 10MG EQUETRO CP12 300MG FIRST-PROGESTERONE VGS SUPP 100MG HALCION TABS 0.25MG DITROPAN XL TB24 5MG ERGOCAL CAPS 62.5 MCG(2500 UT) FIRST-PROGESTERONE VGS SUPP 200MG HECTOROL SOLN 4MCG/2ML DIVALPROEX SODIUM POWD ERYPED 200 SUSR 200MG/5ML FLAGYL TABS 250MG HEMATRON-AF TABS 150-1MG DOLOPHINE TABS 5MG ERYPED 400 SUSR 400MG/5ML FLOLIPID SUSP 20MG/5ML HEMOCYTE PLUS CAPS 106-1MG DONNATAL ELIX 16.2MG/5ML ESCAVITE D CHEW 0.25-6MG FLOLIPID SUSP 40MG/5ML HEPARIN (PORCINE) IN NACL SOLN 5000-0.9UNIT/L-% DONNATAL TABS 16.2MG ESGIC TABS 50-325-40MG FLOMAX CAPS 0.4MG HEPARIN (PORCINE) IN NACL SOLN 5000-0.9UT/500ML-% DOPRAM SOLN 20MG/ML ESMOLOL HCL SOLN 2000MG/100ML FLORIVA CHEW 0.25MG HEPARIN SODIUM (PORCINE) PF SOLN 5000UNIT/ML DORZOLAMIDE HCL SOLN 2% ESMOLOL HCL SOLN 2500MG/250ML FLORIVA CHEW 0.5MG HYCLODEX SOLN 0.012% DORZOLAMIDE HCL-TIMOLOL MAL SOLN 22.3-6.8MG/ML ESTRACE TABS 0.5MG FLORIVA CHEW 1MG HYDRO 35 FOAM 35% DOTAREM SOLN 10MMOL/20ML ESTRACE TABS 1MG FLUMADINE TABS 100MG HYDROMORPHONE HCL PF SOLN 4MG/ML DOTAREM SOLN 2.5MMOL/5ML ESTRACE TABS 2MG FOLTRATE TABS 500-1MCG-MG HYDROMORPHONE HCL SOLN 1MG/ML DOTAREM SOLN 50MMOL/100ML EURAX CREA 10% FOSCAVIR SOLN 6000MG/250ML HYDROMORPHONE HCL-NACL SOLN 12-0.9MG/30ML-% DOTAREM SOLN 5MMOL/10ML EURAX LOTN 10% FUSION PLUS CAPS HYDROMORPHONE HCL-NACL SOLN 15-0.9MG/30ML-% DOTAREM SOLN 7.5MMOL/15ML EVEKEO ODT TBDP 10MG FUSION SPRINKLES PACK 7-0.25-50-5MG HYDROMORPHONE HCL-NACL SOLN 25-0.9MG/50ML-% DOTAREM SOSY 10MMOL/20ML EVEKEO ODT TBDP 15MG HYDROMORPHONE HCL-NACL SOLN 30-0.9MG/30ML-% DOTAREM SOSY 5MMOL/10ML EVEKEO ODT TBDP 20MG G HYDROMORPHONE HCL-NACL SOLN 40-0.9MG/200ML-% DOTAREM SOSY 7.5MMOL/15ML EVEKEO ODT TBDP 5MG GABITRIL TABS 4MG HYDROMORPHONE HCL-NACL SOLN 50-0.9MG/250ML-% DOVER HYDROGEL FOLEY CATH 28FR MISC EVEKEO TABS 10MG GADAVIST SOLN 1MMOL/ML HYDROMORPHONE HCL-NACL SOLN 6-0.9MG/30ML-% DOVER URINE DRAINAGE BAG MISC EVEKEO TABS 5MG GALZIN CAPS 25MG HYDROMORPHONE HCL-NACL SOSY 0.5-0.9MG/ML-% DOXYCYCLINE MONOHYDRATE POWD EVISTA TABS 60MG GALZIN CAPS 50MG HYDROMORPHONE HCL-NACL SOSY 1-0.9MG/5ML-% DRISDOL CAPS 1.25 MG(50000 UT) EVOCLIN FOAM 1% GAMMA-AMINOBUTYRIC ACID CRYS HYDROMORPHONE HCL-NACL SOSY 1-0.9MG/ML-% DUAC GEL 1.2-5% EVOXAC CAPS 30MG GASTROCROM CONC 100MG/5ML HYDROMORPHONE HCL-NACL SOSY 12-0.9MG/30ML-% DUET DHA BALANCED MISC 25-1 & 267MG EXODERM LOTN 25-1% GELCLAIR GEL HYDROMORPHONE HCL-NACL SOSY 55-0.9MG/55ML-% DURACLON SOLN 100MCG/ML GELFOAM SPONGE MISC 12-7MM HYDROMORPHONE HCL-NACL SOSY 6-0.9MG/30ML-% DURLAZA CP24 162.5MG F GEN7T LOTN 3.5% DYAZIDE CAPS 37.5-25MG FAGRON DISPERSAPRO POWD GEN7T PLUS LOTN 3.5-7% I DYMISTA SUSP 137-50MCG/ACT FAZACLO TBDP 12.5MG GILPHEX TR TABS 10-388MG ILEVRO SUSP 0.3% FAZACLO TBDP 25MG GILTUSS TR TABS 10-28-388MG IMPOYZ CREA 0.025% E FELBATOL SUSP 600MG/5ML GLUCOTROL TABS 5MG INDOCIN SUSP 25MG/5ML E-Z-DISK TABS 700MG FELDENE CAPS 10MG GLUCOTROL XL TB24 10MG INFUGEM SOLN 1200-0.9MG/120ML-% E-Z-PAQUE SUSR 96% FEMHRT LOW DOSE TABS 0.5-2.5MG-MCG GLUCOTROL XL TB24 2.5MG INFUGEM SOLN 1400-0.9MG/140ML-% EC-NAPROSYN TBEC 375MG FENOFIBRATE CAPS 150MG GLYCATE TABS 1.5MG INFUGEM SOLN 1600-0.9MG/160ML-% EFFERVESCENT BASE POWD FENTANYL CIT-ROPIVACAINE-NACL SOLN 0.2-0.2-0.9MG/100ML-% GLYCEROL MONOOLEATE POWD INFUGEM SOLN 2200-0.9MG/220ML-% EFUDEX CREA 5% FENTANYL CITRATE SOSY 250MCG/5ML GLYCOPYRROLATE PF SOSY 0.2MG/ML INFUVITE ADULT INJ ELCYS SOLN 50MG/ML FENTANYL CITRATE SOSY 50MCG/5ML GLYCOPYRROLATE SOSY 0.6MG/3ML INOVA 4/1 ACNE CONTROL THERAPY KIT 4 & 1 & 5% ELIXOPHYLLIN ELIX 80MG/15ML FENTANYL CITRATE SOSY 50MCG/ML GLYCOPYRROLATE SOSY 1MG/5ML INOVA KIT 4 & 5% ELLIOTTS B SOLN FENTANYL-BUPIVACAINE-NACL SOLN 0.5-0.1-0.9MG/250ML-% GLYNASE TABS 6MG INOVA KIT 8 & 5%

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. INSYTE AUTOGUARD 18GX1.16" MISC KOSHER PRENATAL PLUS IRON TABS 30-1MG MAGNESIUM SULFATE IN D5W SOLN 1-5GM/50ML-% MIDAZOLAM HCL-SODIUM CHLORIDE SOLN 50-0.9MG/50ML-% INTEGRA PLUS CAPS KRISTALOSE PACK 10GM MAGNESIUM SULFATE IN D5W SOLN 2-5GM/50ML-% MIDAZOLAM HCL-SODIUM CHLORIDE SOSY 5-0.9MG/5ML-% INTEGRILIN SOLN 75MG/100ML KRISTALOSE PACK 20GM MAGNESIUM SULFATE IN D5W SOLN 3-5GM/50ML-% MIDAZOLAM HCL-SODIUM CHLORIDE SOSY 55-0.9MG/55ML-% INTRALIPID EMUL 30% KUDZU POWD MAGNESIUM SULFATE IN D5W SOLN 4-5GM/50ML-% MINIPRESS CAPS 1MG IROSPAN 24/6 MISC MAGNESIUM SULFATE IN D5W SOLN 50-5GM/500ML-% MINIPRESS CAPS 2MG ISOPTO CARPINE SOLN 1% L MAGNESIUM SULFATE-LACT RINGERS SOLN 25GM/250ML MINIPRESS CAPS 5MG ISOPTO CARPINE SOLN 2% L-LEUCINE POWD MAGNESIUM SULFATE-LACT RINGERS SOLN 40GM/500ML MINOCIN CAPS 50MG ISOPTO CARPINE SOLN 4% L-MENTHOL CRYS MAGNESIUM SULFATE-LACT RINGERS SOLN 50GM/500ML MIRAPEX TABS 0.125MG ISORDIL TITRADOSE TABS 5MG L-ORNITHINE HYDROCHLORIDE POWD MAGNESIUM SULFATE-NACL SOLN 1-0.9GM/50ML-% MIRAPEX TABS 0.25MG ISOVUE-250 SOLN 51% L-VALINE CRYS MAGNESIUM SULFATE-NACL SOLN 2-0.9GM/50ML-% MIRAPEX TABS 0.5MG ISOVUE-370 SOLN 76% L.E.T. GEL 4-0.05-0.5% MAGNESIUM SULFATE-NACL SOLN 3-0.9GM/50ML-% MIRAPEX TABS 0.75MG ISOVUE-M 200 SOLN 41% LACRISERT INST 5MG MAGNESIUM SULFATE-NACL SOLN 4-0.9GM/100ML-% MIRAPEX TABS 1.5MG ISOVUE-M 300 SOLN 61% LASTACAFT SOLN 0.25% MAGNESIUM SULFATE-NACL SOLN 4-0.9GM/50ML-% MIRAPEX TABS 1MG LATANOPROST SOLN 0.005% MAGNESIUM SULFATE-NACL SOLN 6-0.9GM/100ML-% MITIGARE CAPS 0.6MG J LAURETH-9 POLIDOCANOL LIQD MAGNESIUM SULFATE-NACL SOLN 6-0.9GM/150ML-% MOBIC TABS 7.5MG JALYN CAPS 0.5-0.4MG LEVBID TB12 0.375MG MALARONE TABS 250-100MG MONOJECT FILTER NEEDLE MISC 18G X 1-1/2" LEVOPHED SOLN 1MG/ML MARCAINE SOLN 0.25% MONOJECT INSULIN SYRINGE MISC 28G X 1/2"1 ML K LEVORPHANOL TARTRATE TABS 3MG MARCAINE SPINAL SOLN 0.75-8.25% MONOJECT INSULIN SYRINGE MISC U-1001 ML K-PHOS NO 2 TABS 305-700MG LEVSIN TABS 0.125MG MARNATAL-F CAPS 60-1MG MONOJECT LUER ADAPTER MISC K-TAB TBCR 10MEQ LEVSIN/SL SUBL 0.125MG MARPLAN TABS 10MG MONOJECT SYRINGE LUER-LOCK TIP MISC 140 ML K-TAB TBCR 20MEQ LIDOCAINE HCL SOSY 10MG/ML MAXFE TABS 160-1MG MORPHINE SULFATE (PF) SOLN 10MG/ML KANGAROO GRAVITY FEEDING SET MISC LIDOCAINE HCL SOSY 200MG/10ML MAXIPIME SOLR 1GM MORPHINE SULFATE (PF) SOLN 10MG/ML KAPVAY TB12 0.1MG LIDOCAINE HCL SOSY 400MG/20ML MAXIPIME SOLR 1GM MORPHINE SULFATE (PF) SOLN 2MG/ML KARBINAL ER SUER 4MG/5ML LIDOCAINE HCL SOSY 60MG/3ML MAXIPIME SOLR 2GM MORPHINE SULFATE (PF) SOLN 4MG/ML KEFLEX CAPS 250MG LIDOCAINE-SODIUM BICARBONATE SOSY 1-8.4% MAXZIDE TABS 75-50MG MORPHINE SULFATE SOLN 0.5MG/ML KEFLEX CAPS 500MG LIDORX GEL 3% MAXZIDE-25 TABS 37.5-25MG MORPHINE SULFATE SOLN 1MG/ML KEFLEX CAPS 750MG LIDTOPIC MAX CREA 10% MEDI-DERM/L-RX CREA 2-0.035-5-20% MORPHINE SULFATE-NACL SOSY 150-0.9MG/30ML-% KENALOG AERS 0.147MG/GM LIQUID POLIBAR PLUS SUSP 105% MEDI-RDT BASE POWD MORPHINE SULFATE-NACL SOSY 2-0.9MG/2ML-% KENALOG SUSP 10MG/ML LOMOTIL TABS 2.5-0.025MG MEDIUM CHAIN TRIGLYCERIDES LIQD MORPHINE SULFATE-NACL SOSY 2-0.9MG/ML-% KENDALL HYDROGEL WOUND DRESS MISC LOPID TABS 600MG MEDROL TABS 16MG MORPHINE SULFATE-NACL SOSY 4-0.9MG/ML-% KERALAC CREA 47% LOPRESSOR TABS 100MG MEDROL TABS 8MG MORPHINE SULFATE-NACL SOSY 5-0.9MG/5ML-% KERALYT GEL 6% LOPROX CREA 0.77% MEDROL TBPK 4MG MOTOFEN TABS 1-0.025MG KERLIX AMD MISC LOPROX SHAM 1% MEDROX-RX OINT 0.05-7-20% MS CONTIN TBCR 15MG KERLIX AMD SUPER SPONGES PADS 6"X6-3/4" LOPROX SUSP 0.77% MEGACE ES SUSP 625MG/5ML MS CONTIN TBCR 30MG KETALAR SOLN 10MG/ML LORZONE TABS 375MG MENEST TABS 0.3MG MUCOLOX LIQD KETAMINE HCL SOSY 30MG/3ML LOTENSIN TABS 10MG MENEST TABS 0.625MG MULTIHANCE SOLN 529MG/ML KETAMINE HCL SOSY 50MG/ML LOTENSIN TABS 20MG MENEST TABS 1.25MG MYCAMINE SOLR 100MG KETAMINE HCL SOSY 50MG/ML LOTENSIN TABS 40MG MENTAX CREA 1% MYCAMINE SOLR 50MG KETAMINE HCL-SODIUM CHLORIDE SOSY 10-0.9MG/ML-% LOTRISONE CREA 1-0.05% MEPERIDINE HCL TABS 50MG MYDRIACYL SOLN 1% KETAMINE HCL-SODIUM CHLORIDE SOSY 100-0.9MG/10ML-% LOVAZA CAPS 1GM MEPRON SUSP 750MG/5ML KETAMINE HCL-SODIUM CHLORIDE SOSY 20-0.9MG/2ML-% LOYON SOLN METANX CAPS 3-90.314-2-35MG N KETOROLAC-BUPIV-KETAMINE SOSY 60-150-60MG/50ML LUXIQ FOAM 0.12% METHACRYLIC ACID COPOLYMER A POWD NAFTIN CREA 2% KETOVIE LIQD LYSTEDA TABS 650MG METHOHEXITAL SODIUM SOSY 100MG/10ML NAFTIN GEL 2% KLARITY-B SOLN 0.1% METHYLIN SOLN 5MG/5ML NALFON TABS 600MG KLARITY-L EMUL 0.2% METHYLPREDNISOLONE ACETATE SUSP 50MG/ML NAMENDA TABS 10MG KLARITY-L EMUL 0.5% M METHYLPREDNISOLONE-BUPIVACAINE SUSP 40-5MG/ML NAMENDA TABS 5MG MACROBID CAPS 100MG KLARON LOTN 10% METROGEL GEL 1% NAMENDA TITRATION PAK TABS 28 X 5 MG &21 X 10 MG MACRODANTIN CAPS 100MG KLONOPIN TABS 0.5MG METROGEL-VAGINAL GEL 0.75% NAPROSYN SUSP 125MG/5ML MACRODANTIN CAPS 50MG KLONOPIN TABS 1MG MICORT-HC CREA 2.5% NARDIL TABS 15MG MAGNESIUM GLYCINATE POWD

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. NAROPIN SOLN 2MG/ML O PCCA XYLIFOS BASE POWD PREDNISOLONE-GATIFLOXACIN SUSP 1-0.5% NAROPIN SOLN 5MG/ML PEDIAPRED SOLN 6.7 (5 BASE)MG/5ML PREDNISOLONE-MOXIFLOXACIN SOLN 1-0.5% O-CAL PRENATAL TABS NAROPIN SOLN 7.5MG/ML PHENERGAN SOLN 50MG/ML PREFEST TABS 1/1-0.09MG (15/15) OB COMPLETE ONE CAPS 50-1-476MG NATACHEW CHEW 28-1MG PHENYLEPHRINE HCL (PRESSORS) SOSY 0.5MG/5ML PRENATE AM TABS 1MG OB COMPLETE PETITE CAPS 35-5-1-200MG NATAZIA TABS 3/2-2/2-3/1MG PHENYLEPHRINE HCL SOSY 0.8MG/10ML PRENATE CHEW 0.6-0.4MG OB COMPLETE PREMIER TABS 30-20-1MG NATELLE ONE CAPS 28-1-250MG PHENYLEPHRINE HCL-DEXTROSE SOLN 8-5MG/100ML-% PRENATE DHA CAPS 18-0.6-0.4-300MG OB COMPLETE TABS 50-1.25MG NEEVO DHA CAPS 27-1.13MG PHENYLEPHRINE HCL-NACL SOLN 30-0.9MG/250ML-% PRENATE ELITE TABS 20-0.6-0.4MG OBSTETRIX ONE CAPS 38-1-225MG HCL TABS 100MG PHENYLEPHRINE HCL-NACL SOLN 40-0.9MG/250ML-% PRENATE ENHANCE CAPS 28-0.6-0.4-400MG OCCLUVAN OINT NEFAZODONE HCL TABS 150MG PHENYLEPHRINE HCL-NACL SOSY 0.2-0.9MG/5ML-% PRENATE MINI CAPS 18-0.6-0.4-350MG OCTAPLAS BLOOD GROUP A SOLN NEFAZODONE HCL TABS 200MG PHENYLEPHRINE HCL-NACL SOSY 1-0.9MG/10ML-% PRENATE PIXIE CAPS 10-0.6-0.4-200MG OCUVEL CAPS 0.5MG NEFAZODONE HCL TABS 250MG PHENYLETHYLAMINE HCL POWD PRENATE RESTORE CAPS 27-0.6-0.4-400MG OFIRMEV SOLN 10MG/ML NEFAZODONE HCL TABS 50MG PHENYLTOLOXAMINE CITRATE POWD PRESTALIA TABS 14-10MG OMECLAMOX-PAK MISC 500-500-20MG NEO-SYNALAR KIT 0.5-0.025% PHENYTEK CAPS 200MG PRESTALIA TABS 3.5-2.5MG OMEGAVEN EMUL 10GM/100ML NEOKE ALCAR POWD PHENYTEK CAPS 300MG PRESTALIA TABS 7-5MG OMEGAVEN EMUL 5GM/50ML NEOSALUS FOAM PITOCIN SOLN 10UNIT/ML PREVIDENT 5000 BOOSTER PLUS PSTE 1.1% OMNIPAQUE SOLN 12MG/ML NEOSTIGMINE METHYLSULFATE SOSY 3MG/3ML PKU EASY MICROTABS TBEC PREVIDENT 5000 ENAMEL PROTECT PSTE 1.1-5% OMNIPAQUE SOLN 9MG/ML NEPHRON FA TABS PKU EASY TABS PRIMACARE CAPS 30-1-470MG OMNISCAN INJ 287MG/ML NESTABS DHA MISC 32-1MG PLEXION CLEANSER LIQD 9.8-4.8% PRINIVIL TABS 10MG OMNISCAN SOLN 287MG/ML NESTABS ONE CAPS 38-1-225MG PLIAGLIS CREA 7-7% PRISMASOL B22GK 4/0 SOLN 22-4MEQ/L ONFI SUSP 2.5MG/ML NETTLE LEAF POWD PNV PRENATAL PLUS MULTIVIT+DHA MISC 27-1 & 312MG PRISMASOL BGK 2/0 SOLN 32-2MEQ/L OPANA TABS 5MG NEUAC KIT 1.2-5% PODOCON SOLN 25% PRISMASOL BGK 2/3.5 SOLN 32-2-3.5MEQ/L OPTIRAY 350 SOLN 74% NEURIN-SL SUBL 600-600MCG POLOXAMER 188 POWD PRISMASOL BGK 4/2.5 SOLN 32-4-2.5MEQ/L ORABLOC SOCT 4%-1:100000 NIACIN POWD POLY-VI-FLOR SUSP 0.25MG/ML PROCARDIA XL TB24 30MG ORACEA CPDR 40MG NIACOR TABS 500MG POLY-VI-FLOR/IRON SUSP 0.25-7MG/ML PROCORT CREA 1.85-1.15% ORAMAGICRX SUSR NIASPAN TBCR 1000MG POLYTRIM SOLN 10000-0.1UNIT/ML-% PROGRAF CAPS 1MG OSPHENA TABS 60MG NIASPAN TBCR 500MG POTASSIUM AZELAOYL DIGLYCINATE LIQD PROHANCE SOLN 279.3MG/ML OVACE PLUS CREA 10% NIASPAN TBCR 750MG POTASSIUM CHLORIDE SOSY 10MEQ/5ML PROLENSA SOLN 0.07% OVACE PLUS FOAM 9.8% NICARDIPINE HCL IN NACL SOSY 1-0.9MG/10ML-% POWDER SCENT FRAGRANCE LIQD PROPECIA TABS 1MG OVACE PLUS SHAM 10% NICOTINAMIDE RIBOSIDE CHLORIDE POWD PRAMOSONE CREA 1-1% PROSCAR TABS 5MG OVACE WASH LIQD 10% NIMBEX SOLN 10MG/5ML PRAMOSONE CREA 1-2.5% PROTEOLIN TABS OVIDE LOTN 0.5% NIMBEX SOLN 20MG/10ML PRAMOSONE LOTN 1-1% PROTOPIC OINT 0.03% OXAYDO TABA 5MG NIPRIDE RTU SOLN 20-0.9MG/100ML-% PRAMOSONE LOTN 1-2.5% PROTOPIC OINT 0.1% OXYTOCIN-LACTATED RINGERS SOLN 20UNIT/L NIPRIDE RTU SOLN 50-0.9MG/100ML-% PRAMOSONE OINT 1-1% PROVERA TABS 10MG OXYTOCIN-SODIUM CHLORIDE SOLN 20-0.9UNT/L-% NITHIODOTE KIT 300MG/10ML&12.5GM/50ML PRAMOSONE OINT 1-2.5% PROVERA TABS 2.5MG OXYTOCIN-SODIUM CHLORIDE SOLN 30-0.9UT/500ML-% NITROSTAT SUBL 0.3MG PRECEDEX SOLN 200MCG/50ML PROVERA TABS 5MG NITROSTAT SUBL 0.4MG P PRECEDEX SOLN 400MCG/100ML PROVIDA OB CAPS 20-20-1.25MG NITROSTAT SUBL 0.6MG PRECOSE TABS 100MG PYRIDIUM TABS 100MG PAINGO KFT KIT 2.5-2.5-10-30% NIZORAL SHAM 2% PRECOSE TABS 25MG PYRIDIUM TABS 200MG PAREMYD SOLN 1-0.25% NOREPINEPHRINE-SODIUM CHLORIDE SOSY 0.16-0.9MG/10ML-% PRECOSE TABS 50MG PYRIDOSTIGMINE BROMIDE TABS 30MG PARLODEL TABS 2.5MG NORPACE CAPS 100MG PREDNISOL ACE-MOXIFLOX-BROMFEN SUSP 1-0.5-0.075% PYRUVIC ACID LIQD PARNATE TABS 10MG NORPACE CAPS 150MG PREDNISOLON-GATIFLOX-BROMFENAC SOLN 1-0.5-0.075% PASER PACK 4GM NORPACE CR CP12 100MG PREDNISOLON-GATIFLOX-BROMFENAC SUSP 1-0.5-0.075% PAXIL CR TB24 12.5MG Q NORPACE CR CP12 150MG PREDNISOLON-MOXIFLOX-BROMFENAC SOLN 1-0.5-0.075% QBREXZA PADS 2.4% PAXIL CR TB24 25MG NORPRAMIN TABS 10MG PREDNISOLON-MOXIFLOX-NEPAFENAC SUSP 1-0.5-0.1% QMIIZ ODT TBDP 15MG PAXIL CR TB24 37.5MG NORPRAMIN TABS 25MG PREDNISOLONE ACET-MOXIFLOXACIN SUSP 1-0.5% QMIIZ ODT TBDP 7.5MG PAXIL SUSP 10MG/5ML NUFERA TABS PREDNISOLONE ACETATE-NEPAFENAC SUSP 1-0.1% QUALAQUIN CAPS 324MG PAXIL TABS 20MG NULYTELY WITH FLAVOR PACKS SOLR 420GM PREDNISOLONE-BROMFENAC SOLN 1-0.075% QUELICIN SOLN 20MG/ML PAXIL TABS 30MG NYMALIZE SOLN 60MG/20ML PREDNISOLONE-BROMFENAC SUSP 1-0.075% QUESTRAN LIGHT POWD 4GM/DOSE PAXIL TABS 40MG PREDNISOLONE-GATIFLOXACIN SOLN 1-0.5% QUESTRAN PACK 4GM PCCA OCCLUSADERM GEL

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. QUESTRAN POWD 4GM/DOSE ROXICODONE TABS 15MG STALEVO 75 TABS 18.75-75-200MG THRIVITE RX TABS 29-1MG QUFLORA FE CHEW 0.25MG ROXICODONE TABS 5MG STARLIX TABS 120MG THYMUS POWD QUFLORA GUMMIES CHEW 0.125MG RYCLORA SOLN 2MG/5ML STROMECTOL TABS 3MG TIAZAC CP24 180MG QUFLORA PEDIATRIC CHEW 0.25MG RYVENT TABS 6MG STROVITE FORTE TABS TIAZAC CP24 300MG QUFLORA PEDIATRIC CHEW 0.5MG SUBOXONE FILM 2-0.5MG TIAZAC CP24 360MG QUFLORA PEDIATRIC CHEW 1MG S SUBOXONE FILM 4-1MG TIAZAC CP24 420MG SALAGEN TABS 5MG SUBOXONE FILM 8-2MG TICARCILLIN-POT CLAVULANATE POWD R SALAGEN TABS 7.5MG SUCCINYLCHOLINE CHLORIDE SOSY 100MG/5ML TIGAN CAPS 300MG R-NATAL OB CAPS 20-1-320MG SALEX SHAM 6% SUCCINYLCHOLINE CHLORIDE SOSY 140MG/7ML TIROSINT CAPS 100MCG RAZADYNE TABS 12MG SALVAX DUO PLUS KIT 6 & 35% SUCCINYLCHOLINE CHLORIDE SOSY 140MG/7ML TIROSINT CAPS 112MCG RAZADYNE TABS 4MG SCLEROSOL INTRAPLEURAL AERP 4GM SUCCINYLCHOLINE CHLORIDE SOSY 200MG/10ML TIROSINT CAPS 125MCG RAZADYNE TABS 8MG SEEBRI NEOHALER CAPS 15.6MCG SUMAXIN WASH LIQD 9-4% TIROSINT CAPS 137MCG READI-CAT 2 SUSP 2% SELECT-OB CHEW 29-0.6-0.4MG SUPPORT-500 CAPS TIROSINT CAPS 13MCG RECK SOSY 123-0.25-0.04-15 MG/50ML SELECT-OB CHEW 29-1MG SUPRANE SOLN TIROSINT CAPS 150MCG RECURA CREA SELRX SHAM 2.3% SUPRAX SUSR 100MG/5ML TIROSINT CAPS 175MCG REGLAN TABS 10MG SEMPREX-D CAPS 8-60MG SUPRAX SUSR 200MG/5ML TIROSINT CAPS 200MCG REGLAN TABS 5MG SERNIVO EMUL 0.05% SYMAX DUOTAB TBCR 0.375MG TIROSINT CAPS 25MCG RELENZA DISKHALER AEPB 5MG/BLISTER SFROWASA ENEM 4GM/60ML SYNALAR (CREAM) KIT 0.025% TIROSINT CAPS 50MCG REMERON SOLTAB TBDP 15MG SILICA GEL SYNALAR (OINTMENT) KIT 0.025% TIROSINT CAPS 75MCG REMERON SOLTAB TBDP 30MG SILOSOME TRANSDERMAL CREA SYNALAR CREA 0.025% TIROSINT CAPS 88MCG REMERON SOLTAB TBDP 45MG SINEMET TABS 25-100MG SYNALAR OINT 0.025% TIROSINT-SOL SOLN 100MCG/ML REMERON TABS 15MG SINEMET TABS 25-250MG SYNALAR SOLN 0.01% TIROSINT-SOL SOLN 112MCG/ML REMERON TABS 30MG SKELAXIN TABS 800MG SYNTHROID TABS 112MCG TIROSINT-SOL SOLN 125MCG/ML RENOVA CREA 0.02% SKLICE LOTN 0.5% SYNTHROID TABS 175MCG TIROSINT-SOL SOLN 137MCG/ML RENVELA TABS 800MG SLYND TABS 4MG SYNTHROID TABS 200MCG TIROSINT-SOL SOLN 13MCG/ML RESTORA RX CAPS 60-1.25MG SODIUM ASPARTATE MONOHYDRATE POWD SYNTHROID TABS 300MCG TIROSINT-SOL SOLN 150MCG/ML RETIN-A CREA 0.025% SODIUM CITRATE-GENTAMICIN SULF SOLN 4-320%-MCG/ML TIROSINT-SOL SOLN 175MCG/ML RETIN-A CREA 0.05% SODIUM NITRITE SOLN 30MG/ML T TIROSINT-SOL SOLN 200MCG/ML RETIN-A CREA 0.1% SODIUM PHOSPHATE DIBASIC POWD TAPAZOLE TABS 10MG TIROSINT-SOL SOLN 25MCG/ML RETIN-A GEL 0.01% SODIUM PHOSPHATE-NACL SOLN 15MMOL/250ML TAPERDEX 12-DAY TBPK 1.5MG (49) TIROSINT-SOL SOLN 50MCG/ML RETIN-A GEL 0.025% SOLU-MEDROL SOLR 40MG TAPERDEX 7-DAY TBPK 1.5MG (27) TIROSINT-SOL SOLN 75MCG/ML RHEOSPRAY LIQD SOLYDRA LIQD TARKA TBCR 2-180MG TIROSINT-SOL SOLN 88MCG/ML RIAX FOAM 5.5% SOMA TABS 250MG TARKA TBCR 2-240MG TOLAK CREA 4% RIAX FOAM 9.5% SORBITOL CANDY BASE CRYS TARKA TBCR 4-240MG TOPICORT CREA 0.05% RIFADIN CAPS 300MG SORBITOL SOLN 3.3% TEGRETOL TABS 200MG TOPICORT CREA 0.25% RIFAMATE CAPS 150-300MG SORBITOL SOLN 3% TEGRETOL-XR TB12 100MG TOPICORT OINT 0.05% RIFATER TABS 50-120-300MG SORBITOL-MANNITOL SOLN 2.7-0.54GM/100ML TEGRETOL-XR TB12 200MG TOPICORT OINT 0.25% RITALIN TABS 10MG SOYABEAN CASEIN DIGEST MEDIUM POWD TEGRETOL-XR TB12 400MG TRAMADOL HCL ER CP24 100MG RITALIN TABS 20MG SPORANOX SOLN 10MG/ML TEMOVATE CREA 0.05% TRAMADOL HCL ER CP24 150MG ROBAXIN SOLN 1000MG/10ML SPRITAM TB3D 1000MG TENORETIC 100 TABS 100-25MG TRECATOR TABS 250MG ROCALTROL CAPS 0.25MCG SPRITAM TB3D 250MG TERAZOL 7 CREA 0.4% TREZIX CAPS 320.5-30-16MG ROCURONIUM BROMIDE SOSY 50MG/5ML SPRITAM TB3D 500MG TERPIN HYDRATE MONOHYDRATE POWD TRI-LUMA CREA 0.01-4-0.05% ROCURONIUM BROMIDE SOSY 75MG/7.5ML SPRITAM TB3D 750MG TESTOSTERONE CYPIONATE SOLN 50MG/ML TRI-VI-FLOR SUSP 0.25MG/ML ROPIV-CLONIDINE-KETOROLAC SOSY 123-0.04-15MG/50ML SSKI SOLN 1GM/ML TEXACORT SOLN 2.5% TRI-VI-FLOR SUSP 0.5MG/ML ROPIVACAINE HCL SOSY 0.2% STALEVO 100 TABS 25-100-200MG THEO-24 CP24 100MG TRICHLOROACETIC ACID CRYS ROPIVACAINE HCL SOSY 0.5% STALEVO 125 TABS 31.25-125-200MG THEO-24 CP24 300MG TRIFERIC SOLN 27.2MG/5ML ROPIVACAINE HCL-NACL SOLN 0.1-0.9% STALEVO 150 TABS 37.5-150-200MG THEO-24 CP24 400MG TRILIPIX CPDR 135MG ROPIVACAINE HCL-NACL SOLN 0.15-0.9% STALEVO 200 TABS 50-200-200MG THEOPHYLLINE-ETHYLENEDIAMINE POWD TRISTART DHA CAPS 31-0.6-0.4-200MG ROPIVACAINE HCL-NACL SOSY 0.2-0.9% STALEVO 50 TABS 12.5-50-200MG THERAMINE PLUS PACK TROPICAMIDE-PHENYLEPHRINE SOLN 1-2.5%

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list. TRULANCE TABS 3MG VIDEX EC CPDR 200MG ZANTAC SOLN 50MG/2ML TRUSOPT SOLN 2% VISTARIL CAPS 25MG ZANTAC TABS 150MG TRUVADA TABS 200-300MG VITAFOL GUMMIES CHEW 3.33-0.333-34.8MG ZELNORM TABS 6MG TUZISTRA XR SUER 14.7-2.8MG/5ML VITAFOL TABS ZEMPLAR SOLN 2MCG/ML TWYNSTA TABS 40-10MG VITAFOL ULTRA CAPS 29-0.6-0.4-200MG ZENZEDI TABS 15MG TWYNSTA TABS 40-5MG VITAFOL-NANO TABS 18-0.6-0.4MG ZENZEDI TABS 2.5MG TWYNSTA TABS 80-10MG VITAFOL-OB+DHA MISC 65-1 & 250MG ZENZEDI TABS 20MG TWYNSTA TABS 80-5MG VITAFOL-ONE CAPS 29-1-200MG ZENZEDI TABS 30MG VITAMEDMD ONE RX/QUATREFOLIC CAPS 30-0.6-0.4-200MG ZENZEDI TABS 7.5MG U VITAMIN E LIQD ZIAC TABS 10-6.25MG UDAMIN SP TABS 1MG VITAMIN K2 POWD 0.2% ZIAC TABS 2.5-6.25MG ULTANE SOLN VITAPEARL CPCR 30-1.4-200MG ZIAC TABS 5-6.25MG ULTRACET TABS 37.5-325MG VITATRUE MISC 30-1.4 & 300MG ZITHROMAX SOLR 500MG ULTRAFOAM SPONGE 2X6.25X7CM MISC VOGELXO GEL 50 MG/5GM(1%) ZOE SCRIPTS IDEALBASE CREA ULTRAVIST SOLN 50% VOLUMEN SUSP 0.1% ZOSYN SOLR 2.25 (2-0.25)GM ULTRAVIST SOLN 62% VP-PNV-DHA CAPS 28-1-215.8MG ZOVIRAX CAPS 200MG UNASYN SOLR 1.5 (1-0.5)GM VRAYLAR CAPS 1.5MG ZYPITAMAG TABS 1MG URECHOLINE TABS 10MG VRAYLAR CAPS 3MG ZYPITAMAG TABS 2MG URECHOLINE TABS 25MG VRAYLAR CAPS 4.5MG ZYPITAMAG TABS 4MG URECHOLINE TABS 50MG VRAYLAR CAPS 6MG ZYVOX SOLN 600MG/300ML URECHOLINE TABS 5MG VSL#3 DS PACK ZYVOX SUSR 100MG/5ML UROCIT-K 5 TBCR 5 MEQ(540 MG) URSO 250 TABS 250MG W UTIBRON NEOHALER CAPS 27.5-15.6MCG WELCHOL TABS 625MG WHITE KIDNEY BEAN EXTRACT POWD V WITEPSOL PLLT VANATOL S SOLN 50-325-40MG/15ML WP THYROID TABS 32.5MG VANCOMYCIN HCL SOLN 1000MG/200ML WP THYROID TABS 48.75MG VANCOMYCIN HCL SOLN 1250MG/12.5ML WP THYROID TABS 97.5MG VANCOMYCIN HCL SOLN 1500MG/300ML VANCOMYCIN HCL SOLN 2000MG/20ML X VANCOMYCIN HCL SOLN 2000MG/400ML XAQUIL XR TBCR 30MG VANCOMYCIN HCL SOLR 250MG XENICAL CAPS 120MG VANILLIN POWD XENLETA SOLN 150MG/15ML VAPRISOL SOLN 20-5MG/100ML-% XOPENEX CONCENTRATE NEBU 1.25MG/0.5ML VARIBAR THIN LIQUID SUSR 40% XOPENEX NEBU 0.31MG/3ML VASOPRESSIN-SODIUM CHLORIDE SOLN 100-0.9UT/100ML-% XOPENEX NEBU 0.63MG/3ML VAZCULEP SOLN 10MG/ML XYLOCAINE SOLN 0.5% VB6 P5P POWD XYLOCAINE-MPF/EPINEPHRINE SOLN 1.5%-1:200000 VECTICAL OINT 3MCG/GM XYLOCAINE-MPF/EPINEPHRINE SOLN 1%-1:200000 VENELEX OINT XYLOCAINE-MPF/EPINEPHRINE SOLN 2%-1:200000 VERELAN CP24 120MG VERELAN CP24 180MG Y VERELAN CP24 240MG YAZ TABS 3-0.02MG VERELAN PM CP24 100MG VERELAN PM CP24 200MG Z VERSACLOZ SUSP 50MG/ML ZANAFLEX CAPS 2MG VIBRAMYCIN SUSR 25MG/5ML ZANAFLEX CAPS 6MG VIDEX EC CPDR 125MG ZANAFLEX TABS 4MG

® VaultRx All rights Reserved 2021 The pricing and inclusion of any prescription drug within this preferred drug list is subject to change and is not guaranteed. While we strive to maintain up to date pricing, drug manufacturers and pharmacies may alter pricing at any time creating the opportunity for an outdated price to be displayed on this preferred drug list before price changes can be updated on this preferred drug list.