COMMERCIAL FORMULARY Effective September 2021 Provided by Elixir

Introduction

The Total Health Care (THC) Commercial Formulary was developed to serve as a guide for physicians, pharmacists, health care professionals and members in the selection of cost-effective drug therapy. Total Health Care recognizes that drug therapy is an integral part of effective health management.

Total Health Care continually reviews new and existing medications to ensure the Formulary remains responsive to the needs of our members and health professionals. Criteria used to evaluate drug selection for the formulary includes, but is not limited to: safety, efficacy and cost-effectiveness data, as well as comparison of relevant benefits of similar prescription or over-the counter (OTC) agents while minimizing potential duplications.

Notice

The information contained in this formulary is provided by THC, solely for the convenience of medical providers and members. THC does not warrant or assure accuracy of this information, nor is it intended to be comprehensive in nature.

This formulary is not intended to be a substitute for the knowledge, expertise, skill or judgment of the medical provider in their choice of prescription drugs. Total Health Care assumes no responsibility for the actions or omissions of any medical provider based upon reliance, in whole or in part, on the information contained herein. The medical provider should consult the drug manufacturer’s product literature or standard references for more detailed information.

How to Read the Formulary

Drug Name

All formulary drugs are listed either by their generic names (in lowercase) or by their brand names (in uppercase). Drugs are grouped together by their therapeutic drug category. Specific drug listings may be accessed by using the index, using the covered generic name or the covered brand name of the drug. The brand names listed are for reference use only, and do not denote coverage, unless specifically noted. Any drug not found in this Formulary listing shall be considered a non-formulary drug.

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Co-Pay Structure

Generic Drug Generic Co-Pay Applies

Brand Drug Brand Co-Pay Applies

Requirements/Limits

This field includes potential limitations to the formulary drug. It also may contain additional information about the coverage of the drug such as applicable quantity limits (QL). For certain agents within the Commercial Formulary, a recommended prescribing guideline may apply.

Prescribing Guidelines

Prescribing guidelines may apply to select drugs on the THC formulary. Prescribing guidelines may vary by benefit design but may include:

Prior Authorization Drug requires prior authorization through a specific physician request Required (PA) process.

Over the Counter Drugs Drug coverage is available for drugs that are available OTC with an (OTC) authorized prescription from your provider.

Specialty Drugs (SP) Drug requires processing through THC’s contracted specialty pharmacy, Elixir Specialty Pharmacy.

Quantity Limit (QL) Drug coverage may be limited to specific quantities per prescription and/or time period.

Age Limit (AL) Drug coverage may depend on patient age.

Gender Restriction (GR) Drug coverage may depend on patient gender.

Step Therapy Required Drug coverage requires that an alternative or trial of another drug be used (ST) before the medication is covered.

Custom (C) Drug coverage has unique restrictions.

Benefit Coverage and Limitations

This formulary does not define benefit coverage and limitations. Members may have specific benefit inclusions, exclusions, copayments, or a lack of coverage, which are not reflected in the Total Health Care Commercial Formulary. Members should contact Total Health Care at 1-800-826-2862 if they have questions regarding their coverage. Please note that the formulary process is evolutionary and changes can occur throughout the year.

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Prior Authorization (PA)

Drugs indicated with a “PA” require Prior Authorization for coverage. A prescriber may complete a Prior Authorization form that can be found on the Total Health Care website at www.THCmi.com. You may also request a form by calling Total Health Care at 1-844-222-5584. Completed prior authorization forms should be faxed to 1-866-422-9119. Prior Authorization review of prescribing guidelines will be evaluated utilizing the established drug review criteria approved by Total Health Care. If the request does not meet the approved criteria, the request will not be approved and alternative therapy may be recommended along with the proper course of alternative action. The requesting provider will be provided written notification of Total Health Care review decisions. THC’s website has a contact link where members can contact THC’s Pharmacy Department to ask for an exception request.

Non-Formulary Agents

A Drug not located on the Total Health Care Commercial Formulary, or any updates published by Total Health Care, shall be considered a non-formulary drug. Requests for coverage of non-formulary agents may be requested by the health professional depending on specific coverage parameters. Review for non- formulary drug requests will require a Prior Authorization request with documentation of medical necessity. Generally, the following basic medical necessity guidelines are used in conducting a review:

. The patient has failed an appropriate trial of formulary or preferred agents. . The use of preferred or formulary agent is contraindicated in the patient. . The formulary drug or preferred agents are not suited for the present patient care need, and the drug selected is required for patient safety.

If the request does not meet the established guidelines request, it will not be approved and alternative therapy may be recommended along with the proper course of alternative action.

Common Drug Exclusions

The member’s plan design may exclude certain drug classes. Prior authorization is generally not available for drugs that are specifically excluded by benefit design. Common excluded coverages may include, but are not limited to:

. OTC medications or their equivalents unless otherwise specified in the Formulary listing. . Drug products used for cosmetic purposes. . Drug products for sexual dysfunction. . Drug products for infertility treatment. . Drug products for weight loss. . Experimental drug products or any drug product used in an experimental manner. . Foreign drugs or drugs not approved by the United States Food & Drug Administration (FDA).

Mandated Generic Substitution

Total Health Care advocates the use of cost-effective generic drugs where FDA-approved generic equivalent drugs are available. Generic products are listed in the Formulary and noted in lowercase lettering wherever an FDA-approved generic drug product is available. If a member or physician requests a brand-name product in lieu of an approved generic, the member, based upon their coverage, will typically be required to pay the difference in cost between the brand and the generic drug.

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Total Health Care Pharmacy and Therapeutics (P&T) Committee

Total Health Care’s Pharmacy & Therapeutics Committee meets quarterly to review and recommend medications for formulary consideration. The Committee considers clinical information on drugs that are new to the market and drugs that are typically included in an outpatient pharmacy benefit. This assures that the formulary remains responsive to patient and physician needs. The Committee is composed of physicians, pharmacists, and health care professionals. The Committee also uses reference materials from our Pharmacy Benefits Manager's Pharmacy and Therapeutics Advisory Panel.

Product Selection Criteria

The primary goal of the THC Pharmacy & Therapeutics Committee is to maintain and update the formulary based upon an objective analysis of the safety, efficacy, approved indications, adverse effects, contraindications, patient administration/compliance considerations and cost effectiveness of available drugs. When a drug is considered for formulary inclusion, it will be reviewed relative to similar drugs including those currently in the THC Commercial Formulary. Physicians may request a copy of THC’s drug criteria by calling the Pharmacy Department at 1-800-826-2862.

Diabetic Testing Supplies

Total Health Care works with J&B Medical Supply to provide diabetic testing supplies to our members. Covered diabetic testing supplies include Glucocard Vital glucometer, Glucocard Expression glucometer, and SD Biosensor GlucoNavii glucometer, Glucocard Vital test strips, Glucocard Expression test strips, SD Biosensor GlucoNavii test strips, lancets, insulin syringes, alcohol swabs and ketone strips. These supplies are to be filled through J&B Medical Supply. If you have any questions about our diabetic supply program, please contact J&B Medical Supply at 1-844-236-7933.

Specialty Bio-Pharmaceutical Pharmacy Program

Total Health Care works with Elixir Specialty Pharmacy to provide Specialty Bio-Pharmaceutical Pharmacy products to our members. These medications are to be filled exclusively through Elixir Specialty Pharmacy.

A Specialty Drug Prior Authorization Request form must be completed and faxed to Elixir at 1-866-422-9119 with supporting documentation and the prescription. A prescriber may obtain a Specialty Drug Prior Authorization Request form found on the Total Health Care website at www.THCmi.com.

Once the order is received, Elixir obtains authorization from Total Health Care. If the specialty prior authorization is approved, Total Health Care notifies Elixir Specialty Pharmacy. Then, the Elixir Specialty Pharmacy staff ships the medication directly to the physician's office or the patient’s home. All packages are individually marked for each patient and refrigerated items are shipped in insulated containers. Where appropriate, each shipment includes needles, syringes and alcohol swabs. If you have any questions about our Specialty Bio-Pharmaceutical Pharmacy program, please contact Elixir at 1-844-222-5584 or Elixir Specialty Pharmacy at 1-877-437-9012.

Contact Information

The Total Health Care Commercial Formulary is designed to assist physicians, members and other health care professionals in the selection of cost-effective agents. Total Health Care encourages your input and feedback on how we can assist in improving this document and the formulary management process. You may contact THC at 1-800-826-2862.

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Medication Limitations

Quantity Limitations

Quantity Limitations are on medications throughout the formulary and are indicated with a "QL" notation. These are medications that have a daily dose restriction, quantity/days’ supply limitation, and/or a limitation on the duration of therapy.

Age Limitations

Age Limitations are on medications throughout the formulary and are indicated with an "AL" notation. Coverage for a medication is indicated by the age limitation. This could be a minimum age, maximum age, and/or the combination of a minimum and maximum age edit.

Gender Restrictions

Gender restrictions are indicated with a “GR” on the formulary and require the member to be a specific gender for coverage.

Step Therapy Criteria

Step Therapy medications are indicated with a “ST” on the formulary and require that an alternative, first line medication be tried and failed before the requested medication can be covered. The online claims adjudication system will automatically allow for the requested medication to be filled based on electronic claims history indicating that the first line medication was filled.

Step Therapy Criteria

Therapy Class First Line Second Line Third Line Step Therapy Criteria

Antimigraine sumatriptan, naratriptan, Prior use of sumatriptan rizatriptan zolmitriptan, AND rizatriptan in the last zolmitriptan odt 90 days. Antipsychotic risperidone, quetiapine ER Prior use for 30 days of Agents quetiapine quetiapine IR, olanzapine, immediate-release, risperidone, or ziprasidone olanzapine

Anticonvulsants lamotrigine IR lamotrigine ER Prior use for 30 days of lamotrigine IR

Urinary oxybutynin, t olterodine, darifenacin ER, Secon d Line: Prior use of Antispasmodics oxybutynin ER, t olterodine ER, t rospium ER, O XYTROL OTC, oxybutynin syrup, t rospium solifenacin oxybutynin, oxybutynin OXYTROL OTC ER, or oxybutynin syrup in the last 90 days. Third Line: Prior use of tolterodine, tolterodine ER, or trospium in the last 90 days.

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*Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of Elixir. The presence of a medication on this formulary list does not guarantee coverage.

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CURRENT AS OF 9/1/2021

Notes AL = Age Limit GR-F = Female Only GR-M = Male Only PA = Prior Authorization PDL-NP = PDL Non-Preferred lowercase italics = Generic drugs PDL-P = PDL Preferred UPPERCASE BOLD = Brand Status QL = Quantity Limit name drugs T1 = Covered ST = Step Therapy Drug Status Notes *Adhd/Anti-Narcolepsy/Anti- Obesity/Anorexiants* amphetamine-dextroamphet er oral capsule QL (30 EA per 30 days); AL (Min T1 extended release 24 hour 10 mg, 15 mg, 5 mg 6 Years) amphetamine-dextroamphet er oral capsule QL (60 EA per 30 days); AL (Min T1 extended release 24 hour 20 mg, 25 mg, 30 mg 6 Years) amphetamine-dextroamphetamine oral tablet 10 QL (120 EA per 30 days); AL T1 mg, 12.5 mg, 15 mg (Min 6 Years) amphetamine-dextroamphetamine oral tablet 20 QL (90 EA per 30 days); AL (Min T1 mg, 5 mg, 7.5 mg 6 Years) amphetamine-dextroamphetamine oral tablet 30 QL (60 EA per 30 days); AL (Min T1 mg 6 Years) armodafinil oral tablet 150 mg, 200 mg, 250 mg, T1 QL (30 EA per 30 days) 50 mg atomoxetine hcl oral capsule 10 mg, 100 mg, 18 T1 QL (60 EA per 30 days) mg, 25 mg, 40 mg, 60 mg, 80 mg dexmethylphenidate hcl er oral capsule extended QL (30 EA per 30 days); AL (Min release 24 hour 10 mg, 15 mg, 20 mg, 25 mg, 30 T1 4 Years) mg, 35 mg, 40 mg, 5 mg QL (150 EA per 30 days); AL dexmethylphenidate hcl oral tablet 10 mg, 5 mg T1 (Min 4 Years) QL (90 EA per 30 days); AL (Min dexmethylphenidate hcl oral tablet 2.5 mg T1 4 Years) dextroamphetamine sulfate er oral capsule T1 extended release 24 hour 10 mg, 15 mg, 5 mg dextroamphetamine sulfate oral tablet 10 mg T1 QL (180 EA per 30 days) dextroamphetamine sulfate oral tablet 5 mg T1 QL (360 EA per 30 days) guanfacine hcl er oral tablet extended release 24 T1 QL (60 EA per 30 days) hour 1 mg, 2 mg, 3 mg, 4 mg methylphenidate hcl er (cd) oral capsule extended QL (30 EA per 30 days); AL (Min release 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 T1 4 Years) mg

1 Drug Status Notes methylphenidate hcl er (la) oral capsule extended QL (30 EA per 30 days); AL (Min release 24 hour 10 mg, 20 mg, 30 mg, 40 mg, 60 T1 4 Years and Max 10 Years) mg methylphenidate hcl er oral tablet extended QL (300 EA per 30 days); AL T1 release 10 mg (Min 4 Years) methylphenidate hcl er oral tablet extended T1 QL (30 EA per 30 days) release 18 mg, 27 mg methylphenidate hcl er oral tablet extended QL (150 EA per 30 days); AL T1 release 20 mg (Min 4 Years) methylphenidate hcl er oral tablet extended QL (30 EA per 30 days); AL (Min T1 release 24 hour 18 mg, 27 mg 4 Years and Max 10 Years) methylphenidate hcl er oral tablet extended QL (60 EA per 30 days); AL (Min T1 release 24 hour 36 mg, 54 mg 4 Years and Max 10 Years) methylphenidate hcl er oral tablet extended T1 QL (60 EA per 30 days) release 36 mg, 54 mg QL (600 ML per 30 days); AL methylphenidate hcl oral solution 5 mg/5ml T1 (Min 4 Years and Max 10 Years) QL (300 EA per 30 days); AL methylphenidate hcl oral tablet 10 mg T1 (Min 4 Years) QL (150 EA per 30 days); AL methylphenidate hcl oral tablet 20 mg T1 (Min 4 Years) QL (600 EA per 30 days); AL methylphenidate hcl oral tablet 5 mg T1 (Min 4 Years) QL (300 EA per 30 days); AL methylphenidate hcl oral tablet chewable 10 mg T1 (Min 4 Years and Max 10 Years) QL (1200 EA per 30 days); AL methylphenidate hcl oral tablet chewable 2.5 mg T1 (Min 4 Years and Max 10 Years) QL (600 EA per 30 days); AL methylphenidate hcl oral tablet chewable 5 mg T1 (Min 4 Years and Max 10 Years) modafinil oral tablet 100 mg, 200 mg T1 PA VYVANSE ORAL CAPSULE 10 MG, 20 MG, ST; QL (30 EA per 30 days); AL T1 30 MG, 40 MG, 50 MG, 60 MG, 70 MG (Min 6 Years and Max 17 Years) *Aminoglycosides* neomycin sulfate oral tablet 500 mg T1 *Analgesics - Anti-Inflammatory* celecoxib oral capsule 100 mg, 200 mg, 400 mg, T1 QL (60 EA per 30 days) 50 mg diclofenac potassium oral tablet 50 mg T1 diclofenac sodium er oral tablet extended release T1 24 hour 100 mg diclofenac sodium oral tablet delayed release 25 T1 mg, 50 mg, 75 mg

2 Drug Status Notes ENBREL SUBCUTANEOUS SOLUTION PREFILLED SYRINGE 25 MG/0.5ML, 50 T1 PA MG/ML ENBREL SUBCUTANEOUS SOLUTION T1 PA RECONSTITUTED 25 MG ENBREL SURECLICK SUBCUTANEOUS T1 PA SOLUTION AUTO-INJECTOR 50 MG/ML fenoprofen calcium oral tablet 600 mg T1 flurbiprofen oral tablet 100 mg, 50 mg T1 HUMIRA PEDIATRIC CROHNS START SUBCUTANEOUS PREFILLED SYRINGE T1 PA KIT 40 MG/0.8ML HUMIRA PEN SUBCUTANEOUS PEN- T1 PA INJECTOR KIT 40 MG/0.8ML HUMIRA PEN-CD/UC/HS STARTER SUBCUTANEOUS PEN-INJECTOR KIT 40 T1 PA MG/0.8ML HUMIRA PEN-PS/UV/ADOL HS START SUBCUTANEOUS PEN-INJECTOR KIT 40 T1 PA MG/0.8ML HUMIRA SUBCUTANEOUS PREFILLED SYRINGE KIT 10 MG/0.2ML, 20 MG/0.4ML, T1 PA 40 MG/0.8ML ibuprofen oral capsule 200 mg T1 ibuprofen oral suspension 100 mg/5ml T1 ibuprofen oral tablet 200 mg, 400 mg, 600 mg, T1 800 mg INDOCIN ORAL SUSPENSION 25 MG/5ML T1 indomethacin oral capsule 25 mg, 50 mg T1 ketoprofen oral capsule 50 mg T1 QL (360 EA per 30 days) ketoprofen oral capsule 75 mg T1 QL (120 EA per 30 days) ketorolac tromethamine oral tablet 10 mg T1 QL (20 EA per 5 days) leflunomide oral tablet 10 mg, 20 mg T1 meloxicam oral tablet 15 mg, 7.5 mg T1 nabumetone oral tablet 500 mg T1 QL (120 EA per 30 days) nabumetone oral tablet 750 mg T1 QL (60 EA per 30 days) NAPROXEN COMFORT PAC T1 COMBINATION KIT 500 MG naproxen dr oral tablet delayed release 375 mg T1 naproxen oral tablet 250 mg, 375 mg, 500 mg T1 naproxen powder T1 naproxen sodium oral capsule 220 mg T1

3 Drug Status Notes naproxen sodium oral tablet 220 mg T1 oxaprozin oral tablet 600 mg T1 piroxicam oral capsule 10 mg, 20 mg T1 sulindac oral tablet 150 mg, 200 mg T1 *Analgesics - Nonnarcotic* ACEPHEN RECTAL SUPPOSITORY 325 T1 MG acetaminophen er oral tablet extended release T1 650 mg acetaminophen oral capsule 500 mg T1 acetaminophen oral elixir 160 mg/5ml T1 acetaminophen oral suspension 160 mg/5ml T1 acetaminophen oral tablet 325 mg, 500 mg T1 acetaminophen rectal suppository 120 mg T1 adult aspirin low strength oral tablet dispersible QL (30 EA per 30 days); AL (Min T1 81 mg 40 Years and Max 79 Years) apap oral tablet chewable 80 mg T1 ASCRIPTIN ORAL TABLET 325 MG T1 aspirin adult low strength oral tablet delayed QL (60 EA per 30 days); AL (Min T1 release 81 mg 40 Years and Max 79 Years) QL (60 EA per 30 days); AL (Min aspirin low dose oral tablet chewable 81 mg T1 40 Years and Max 79 Years) QL (30 EA per 30 days); AL (Min aspirin oral tablet 325 mg T1 40 Years and Max 79 Years) QL (60 EA per 30 days); AL (Min aspirin oral tablet 81 mg T1 40 Years and Max 79 Years) QL (30 EA per 30 days); AL (Min aspirin oral tablet delayed release 325 mg T1 40 Years and Max 79 Years) aspirin rectal suppository 300 mg, 600 mg T1 aspirtab maximum strength oral tablet 500 mg T1 QL (30 EA per 30 days); AL (Min buffasal oral tablet 324 mg T1 40 Years and Max 79 Years) QL (30 EA per 30 days); AL (Min buffered aspirin oral tablet 325 mg T1 40 Years and Max 79 Years) butalbital-acetaminophen oral tablet 50-325 mg T1 butalbital-apap-caffeine oral tablet 50-325-40 mg T1 butalbital-aspirin-caffeine oral capsule 50-325- T1 40 mg choline & mag trisalicylate oral tablet 1000 mg T1 choline-mag trisalicylate oral liquid 500 mg/5ml T1 diflunisal oral tablet 500 mg T1 4 Drug Status Notes infants pain relief oral suspension 80 mg/0.8ml T1 migraine relief oral tablet 250-250-65 mg T1 q-pap infants oral solution 80 mg/0.8ml T1 q-pap oral liquid 160 mg/5ml T1 salsalate oral tablet 500 mg, 750 mg T1 *Analgesics - Opioid* acetaminophen-codeine #2 oral tablet 300-15 mg T1 QL (390 EA per 30 days) acetaminophen-codeine #3 oral tablet 300-30 mg T1 QL (390 EA per 30 days) acetaminophen-codeine #4 oral tablet 300-60 mg T1 QL (390 EA per 30 days) acetaminophen-codeine oral solution 120-12 T1 mg/5ml butalbital-apap-caff-cod oral capsule 50-325-40- T1 30 mg butalbital-asa-caff-codeine oral capsule 50-325- T1 40-30 mg codeine sulfate oral tablet 15 mg, 30 mg, 60 mg T1 fentanyl transdermal patch 72 hour 100 mcg/hr, T1 QL (10 EA per 30 days) 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr hydrocodone-acetaminophen oral solution 10-325 T1 QL (900 ML per 90 days) mg/15ml, 7.5-325 mg/15ml hydrocodone-acetaminophen oral tablet 10-325 T1 QL (180 EA per 30 days) mg, 7.5-325 mg hydrocodone-acetaminophen oral tablet 5-325 mg T1 QL (360 EA per 30 days) hydromorphone hcl oral tablet 2 mg, 4 mg, 8 mg T1 QL (240 EA per 30 days) LORTAB ORAL ELIXIR 10-300 MG/15ML T1 QL (900 ML per 90 days) meperidine hcl oral tablet 100 mg, 50 mg T1 methadone hcl oral concentrate 10 mg/ml T1 methadone hcl oral solution 10 mg/5ml, 5 mg/5ml T1 methadone hcl oral tablet 10 mg T1 QL (240 EA per 30 days) methadone hcl oral tablet 5 mg T1 QL (120 EA per 30 days) methadone hcl oral tablet soluble 40 mg T1 morphine sulfate (concentrate) oral solution 100 T1 mg/5ml morphine sulfate er oral tablet extended release T1 QL (90 EA per 30 days) 100 mg, 15 mg, 30 mg, 60 mg morphine sulfate oral solution 10 mg/5ml, 20 T1 mg/5ml morphine sulfate oral tablet 15 mg, 30 mg T1 QL (180 EA per 30 days) oxycodone hcl oral concentrate 100 mg/5ml T1 oxycodone hcl oral solution 5 mg/5ml T1

5 Drug Status Notes oxycodone hcl oral tablet 10 mg, 15 mg, 20 mg, T1 QL (180 EA per 30 days) 30 mg, 5 mg oxycodone-acetaminophen oral tablet 10-325 mg, T1 QL (180 EA per 30 days) 7.5-325 mg oxycodone-acetaminophen oral tablet 5-325 mg T1 QL (360 EA per 30 days) oxycodone-aspirin oral tablet 4.8355-325 mg T1 tramadol hcl oral tablet 50 mg T1 QL (240 EA per 30 days) *Androgens-Anabolic* testosterone cypionate intramuscular solution 100 T1 GR-M mg/ml, 200 mg/ml testosterone enanthate intramuscular solution T1 GR-M 200 mg/ml *Anorectal And Related Products* FLEET NATURALS CLEANSING ENEMA T1 RECTAL ENEMA hydrocortisone rectal enema 100 mg/60ml T1 *Antacids* ALKA-SELTZER HEARTBURN ORAL T1 TABLET EFFERVESCENT 1940-1000 MG ALMACONE ORAL TABLET CHEWABLE T1 200-200-25 MG antacid & antigas oral suspension 200-200-20 T1 mg/5ml, 400-400-40 mg/5ml antacid extra strength oral tablet chewable 675- T1 135 mg antacid multi-symptom oral tablet chewable 675- T1 135-60 mg antacid oral tablet chewable 1177 mg, 350-150 T1 mg, 420 mg, 550-110 mg calcium antacid ultra oral tablet chewable 1000 T1 mg calcium carbonate antacid oral tablet 648 mg T1 calcium carbonate antacid oral tablet chewable T1 500 mg, 750 mg CHILDRENS SOOTHE ORAL TABLET T1 CHEWABLE 400 MG CITROCARBONATE ORAL GRANULES T1 EFFERVESCENT 0.78-1.82 GM/DOSE cvs antacid & anti-gas oral tablet chewable 1000- T1 60 mg cvs antacid supreme oral suspension 400-135 T1 mg/5ml

6 Drug Status Notes cvs heartburn relief ex st oral suspension 254- T1 237.5 mg/5ml DEWEES CARMINATIVE ORAL LIQUID 6- T1 250 E-Z-GAS II ORAL PACKET 2.21-1.53-0.04 T1 GM GAVISCON ORAL TABLET CHEWABLE T1 80-14.2 MG gnp foaming antacid oral suspension 95-358 T1 mg/15ml gnp foaming antacid oral tablet chewable 80-20 T1 mg heartburn antacid ex st oral tablet chewable 160- T1 105 mg mag-al oral liquid 200-200 mg/5ml T1 magnesium oxide oral capsule 400 mg T1 magnesium oxide oral tablet 250 mg, 400 mg T1 magnesium oxide powder T1 MAOX ORAL TABLET 420 MG T1 MI-ACID ORAL TABLET CHEWABLE 700- T1 300 MG sodium bicarbonate oral powder T1 sodium bicarbonate oral tablet 325 mg, 650 mg T1 URO-MAG ORAL CAPSULE 140 MG T1 *Anthelmintics* ivermectin oral tablet 3 mg T1 QL (20 EA per 90 days) PIN-X ORAL SUSPENSION 50 MG/ML T1 PIN-X ORAL TABLET CHEWABLE 720.5 T1 MG reeses pinworm medicine oral suspension 144 (50 T1 base) mg/ml *Antianginal Agents* isosorbide dinitrate er oral tablet extended T1 release 40 mg isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 T1 mg, 5 mg isosorbide mononitrate er oral tablet extended T1 release 24 hour 120 mg, 30 mg, 60 mg isosorbide mononitrate oral tablet 10 mg, 20 mg T1 NITRO-BID TRANSDERMAL OINTMENT 2 T1 %

7 Drug Status Notes nitroglycerin er oral capsule extended release 2.5 T1 mg, 6.5 mg, 9 mg nitroglycerin sublingual tablet sublingual 0.3 mg, T1 0.4 mg, 0.6 mg nitroglycerin transdermal patch 24 hour 0.1 T1 mg/hr, 0.2 mg/hr, 0.4 mg/hr, 0.6 mg/hr ranolazine er oral tablet extended release 12 hour T1 QL (60 EA per 30 days) 1000 mg, 500 mg *Antianxiety Agents* alprazolam oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 T1 AL (Max 64 Years) mg buspirone hcl oral tablet 10 mg, 15 mg, 30 mg, 5 T1 mg chlordiazepoxide hcl oral capsule 10 mg, 25 mg, T1 AL (Max 64 Years) 5 mg clorazepate dipotassium oral tablet 15 mg, 3.75 T1 mg clorazepate dipotassium oral tablet 7.5 mg T1 AL (Max 64 Years) diazepam injection solution 5 mg/ml T1 diazepam oral solution 1 mg/ml T1 AL (Max 64 Years) diazepam oral tablet 10 mg, 2 mg, 5 mg T1 AL (Max 64 Years) hydroxyzine hcl oral syrup 10 mg/5ml T1 AL (Max 64 Years) hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg T1 AL (Max 64 Years) hydroxyzine pamoate oral capsule 100 mg T1 hydroxyzine pamoate oral capsule 25 mg, 50 mg T1 AL (Max 64 Years) lorazepam oral tablet 0.5 mg, 1 mg, 2 mg T1 oxazepam oral capsule 10 mg, 15 mg, 30 mg T1 *Antiarrhythmics* amiodarone hcl oral tablet 100 mg, 200 mg, 400 T1 mg disopyramide phosphate oral capsule 100 mg, T1 150 mg flecainide acetate oral tablet 100 mg, 150 mg, 50 T1 mg MULTAQ ORAL TABLET 400 MG T1 QL (60 EA per 30 days) NORPACE CR ORAL CAPSULE T1 QL (60 EA per 30 days) EXTENDED RELEASE 12 HOUR 100 MG NORPACE CR ORAL CAPSULE T1 QL (120 EA per 30 days) EXTENDED RELEASE 12 HOUR 150 MG propafenone hcl oral tablet 150 mg, 225 mg, 300 T1 mg

8 Drug Status Notes quinidine gluconate er oral tablet extended T1 release 324 mg quinidine sulfate oral tablet 200 mg, 300 mg T1 *Antiasthmatic And Bronchodilator Agents* ADVAIR DISKUS INHALATION AEROSOL QL (60 EA per 30 days); AL (Max POWDER BREATH ACTIVATED 100-50 T1 11 Years) MCG/DOSE AEROSPAN INHALATION AEROSOL T1 QL (8.9 GM per 30 days) SOLUTION 80 MCG/ACT albuterol sulfate inhalation nebulization solution T1 (2.5 mg/3ml) 0.083%, (5 mg/ml) 0.5% albuterol sulfate oral syrup 2 mg/5ml T1 ANORO ELLIPTA INHALATION AEROSOL POWDER BREATH T1 PA; QL (60 EA per 30 days) ACTIVATED 62.5-25 MCG/INH ATROVENT HFA INHALATION AEROSOL T1 QL (12.9 GM per 30 days) SOLUTION 17 MCG/ACT BREO ELLIPTA INHALATION AEROSOL POWDER BREATH ACTIVATED 100-25 T1 QL (60 EA per 30 days) MCG/INH, 200-25 MCG/INH budesonide inhalation suspension 0.25 mg/2ml, T1 AL (Max 6 Years) 0.5 mg/2ml budesonide-formoterol fumarate aerosol 160-4.5 T1 QL (10.2 GM per 30 days) mcg/act inhalation 160-4.5 mcg/act budesonide-formoterol fumarate aerosol 80-4.5 T1 QL (10.2 GM per 30 days) mcg/act inhalation 80-4.5 mcg/act DIFIL-G FORTE ORAL LIQUID 100-100 T1 MG/5ML DULERA INHALATION AEROSOL 100-5 T1 QL (13 GM per 30 days) MCG/ACT, 200-5 MCG/ACT FASENRA SUBCUTANEOUS SOLUTION T1 PA PREFILLED SYRINGE 30 MG/ML FLOVENT DISKUS INHALATION AEROSOL POWDER BREATH QL (60 EA per 30 days); AL (Min T1 ACTIVATED 100 MCG/BLIST, 50 4 Years and Max 11 Years) MCG/BLIST FLOVENT HFA INHALATION AEROSOL QL (10.6 GM per 30 days); AL T1 44 MCG/ACT (Min 4 Years and Max 11 Years) fluticasone-salmeterol aerosol powder breath activated 113-14 mcg/act inhalation 113-14 T1 QL (1 EA per 30 days) mcg/act

9 Drug Status Notes fluticasone-salmeterol aerosol powder breath activated 232-14 mcg/act inhalation 232-14 T1 QL (1 EA per 30 days) mcg/act fluticasone-salmeterol aerosol powder breath T1 QL (1 EA per 30 days) activated 55-14 mcg/act inhalation 55-14 mcg/act FORADIL AEROLIZER INHALATION T1 QL (60 EA per 30 days) CAPSULE 12 MCG formoterol fumarate inhalation nebulization T1 solution 20 mcg/2ml INCRUSE ELLIPTA INHALATION AEROSOL POWDER BREATH T1 QL (30 EA per 30 days) ACTIVATED 62.5 MCG/INH ipratropium bromide inhalation solution 0.02 % T1 LUFYLLIN ORAL TABLET 200 MG, 400 T1 MG metaproterenol sulfate oral syrup 10 mg/5ml T1 metaproterenol sulfate oral tablet 10 mg, 20 mg T1 montelukast sodium oral tablet 10 mg T1 montelukast sodium oral tablet chewable 4 mg, 5 T1 mg QVAR INHALATION AEROSOL T1 QL (8.7 GM per 30 days) SOLUTION 40 MCG/ACT, 80 MCG/ACT QVAR REDIHALER INHALATION AEROSOL BREATH ACTIVATED 40 T1 QL (10.6 GM per 30 days) MCG/ACT, 80 MCG/ACT SEREVENT DISKUS INHALATION AEROSOL POWDER BREATH T1 QL (120 EA per 30 days) ACTIVATED 50 MCG/DOSE STRIVERDI RESPIMAT INHALATION T1 QL (4 GM per 30 days) AEROSOL SOLUTION 2.5 MCG/ACT terbutaline sulfate oral tablet 2.5 mg, 5 mg T1 THEO-24 ORAL CAPSULE EXTENDED RELEASE 24 HOUR 100 MG, 200 MG, 300 T1 MG THEOCHRON ORAL TABLET EXTENDED T1 RELEASE 12 HOUR 200 MG theophylline er oral tablet extended release 12 T1 hour 100 mg, 300 mg, 450 mg theophylline er oral tablet extended release 24 T1 hour 400 mg theophylline oral solution 80 mg/15ml T1 VENTOLIN HFA AEROSOL SOLUTION 108 (90 BASE) MCG/ACT INHALATION 108 (90 T1 QL (36 GM per 28 days) BASE) MCG/ACT 10 Drug Status Notes *Anticoagulants* ELIQUIS ORAL TABLET 2.5 MG, 5 MG T1 QL (60 EA per 30 days) enoxaparin sodium injection solution 300 mg/3ml T1 enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, T1 40 mg/0.4ml, 60 mg/0.6ml, 80 mg/0.8ml heparin sodium (porcine) injection solution 1000 unit/ml, 10000 unit/ml, 20000 unit/ml, 5000 T1 unit/ml heparin sodium (porcine) intravenous solution T1 2000 unit/ml heparin sodium (porcine) pf injection solution T1 5000 unit/0.5ml JANTOVEN ORAL TABLET 1 MG, 10 MG, 2 MG, 2.5 MG, 3 MG, 4 MG, 5 MG, 6 MG, 7.5 T1 MG warfarin sodium oral tablet 1 mg, 10 mg, 2 mg, T1 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg XARELTO ORAL TABLET 10 MG T1 QL (30 EA per 30 days) XARELTO ORAL TABLET 15 MG, 2.5 MG, T1 QL (60 EA per 30 days) 20 MG *Anticonvulsants* carbamazepine er oral capsule extended release T1 12 hour 300 mg carbamazepine er oral tablet extended release 12 T1 hour 200 mg, 400 mg carbamazepine oral suspension 100 mg/5ml T1 carbamazepine oral tablet 200 mg T1 carbamazepine oral tablet chewable 100 mg T1 clonazepam oral tablet 0.5 mg, 1 mg, 2 mg T1 DIASTAT ACUDIAL RECTAL GEL 10 MG, T1 QL (2 EA per 30 days) 20 MG diazepam rectal gel 10 mg, 2.5 mg, 20 mg T1 QL (2 EA per 30 days) DILANTIN ORAL CAPSULE 100 MG, 30 T1 MG divalproex sodium er oral tablet extended release T1 24 hour 250 mg, 500 mg divalproex sodium oral capsule delayed release T1 sprinkle 125 mg divalproex sodium oral tablet delayed release 125 T1 mg, 250 mg, 500 mg EPITOL ORAL TABLET 200 MG T1

11 Drug Status Notes ethosuximide oral capsule 250 mg T1 ethosuximide oral solution 250 mg/5ml T1 fosphenytoin sodium injection solution 100 mg T1 pe/2ml, 500 mg pe/10ml gabapentin oral capsule 100 mg, 300 mg, 400 mg T1 gabapentin oral solution 250 mg/5ml T1 gabapentin oral tablet 600 mg, 800 mg T1 lamotrigine er oral tablet extended release 24 hour 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 T1 ST; QL (30 EA per 30 days) mg lamotrigine oral tablet 100 mg, 150 mg, 200 mg, T1 25 mg lamotrigine oral tablet chewable 25 mg, 5 mg T1 levetiracetam oral solution 100 mg/ml T1 levetiracetam oral tablet 1000 mg T1 QL (90 EA per 30 days) levetiracetam oral tablet 250 mg T1 QL (360 EA per 30 days) levetiracetam oral tablet 500 mg T1 QL (180 EA per 30 days) levetiracetam oral tablet 750 mg T1 QL (120 EA per 30 days) oxcarbazepine oral tablet 150 mg, 300 mg, 600 T1 mg phenytoin oral suspension 125 mg/5ml T1 QL (750 ML per 30 days) phenytoin oral tablet chewable 50 mg T1 phenytoin sodium extended oral capsule 100 mg T1 phenytoin sodium injection solution 50 mg/ml T1 pregabalin oral capsule 100 mg, 150 mg, 200 mg, T1 QL (90 EA per 30 days) 225 mg, 25 mg, 300 mg, 50 mg, 75 mg primidone oral tablet 250 mg, 50 mg T1 topiramate oral capsule sprinkle 15 mg, 25 mg T1 topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 T1 mg valproic acid oral capsule 250 mg T1 valproic acid oral solution 250 mg/5ml T1 zonisamide oral capsule 100 mg T1 QL (180 EA per 30 days) zonisamide oral capsule 25 mg, 50 mg T1 QL (360 EA per 30 days) *Antidepressants* amitriptyline hcl oral tablet 10 mg, 100 mg, 150 T1 AL (Max 64 Years) mg, 25 mg, 50 mg, 75 mg amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 T1 AL (Max 64 Years) mg

12 Drug Status Notes bupropion hcl er (sr) oral tablet extended release T1 12 hour 100 mg, 150 mg, 200 mg bupropion hcl er (xl) oral tablet extended release T1 24 hour 150 mg, 300 mg bupropion hcl oral tablet 100 mg, 75 mg T1 citalopram hydrobromide oral tablet 10 mg, 20 T1 mg, 40 mg doxepin hcl oral capsule 10 mg, 100 mg, 150 mg, T1 AL (Max 64 Years) 25 mg, 50 mg, 75 mg doxepin hcl oral concentrate 10 mg/ml T1 AL (Max 64 Years) duloxetine hcl oral capsule delayed release T1 QL (60 EA per 30 days) particles 20 mg duloxetine hcl oral capsule delayed release T1 QL (30 EA per 30 days) particles 30 mg, 60 mg escitalopram oxalate oral solution 5 mg/5ml T1 escitalopram oxalate oral tablet 10 mg, 5 mg T1 QL (45 EA per 30 days) escitalopram oxalate oral tablet 20 mg T1 QL (30 EA per 30 days) fluoxetine hcl oral capsule 10 mg, 20 mg, 40 mg T1 fluoxetine hcl oral solution 20 mg/5ml T1 fluvoxamine maleate oral tablet 100 mg, 25 mg, T1 50 mg imipramine hcl oral tablet 10 mg, 25 mg, 50 mg T1 AL (Max 64 Years) mirtazapine oral tablet 15 mg, 30 mg, 45 mg T1 AL (Max 64 Years) nortriptyline hcl oral capsule 10 mg, 25 mg, 50 T1 mg, 75 mg nortriptyline hcl oral solution 10 mg/5ml T1 paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, T1 40 mg phenelzine sulfate oral tablet 15 mg T1 sertraline hcl oral concentrate 20 mg/ml T1 sertraline hcl oral tablet 100 mg, 25 mg, 50 mg T1 tranylcypromine sulfate oral tablet 10 mg T1 PA trazodone hcl oral tablet 100 mg, 150 mg, 50 mg T1 venlafaxine hcl er oral capsule extended release T1 24 hour 150 mg, 37.5 mg, 75 mg venlafaxine hcl oral tablet 100 mg, 25 mg, 37.5 T1 mg, 50 mg, 75 mg *Antidiabetics* acarbose oral tablet 100 mg, 25 mg, 50 mg T1 alogliptin benzoate oral tablet 12.5 mg, 25 mg, T1 QL (30 EA per 30 days) 6.25 mg

13 Drug Status Notes alogliptin-metformin hcl oral tablet 12.5-1000 mg T1 QL (60 EA per 30 days) alogliptin-metformin hcl oral tablet 12.5-500 mg T1 QL (30 EA per 30 days) alogliptin-pioglitazone oral tablet 12.5-15 mg, 12.5-30 mg, 12.5-45 mg, 25-15 mg, 25-30 mg, 25- T1 QL (30 EA per 30 days) 45 mg chlorpropamide oral tablet 100 mg, 250 mg T1 FIASP FLEXTOUCH SOLUTION PEN- INJECTOR 100 UNIT/ML SUBCUTANEOUS T1 100 UNIT/ML FIASP PENFILL SOLUTION CARTRIDGE 100 UNIT/ML SUBCUTANEOUS 100 T1 UNIT/ML FIASP SUBCUTANEOUS SOLUTION 100 T1 UNIT/ML glimepiride oral tablet 1 mg, 2 mg, 4 mg T1 glipizide oral tablet 10 mg, 5 mg T1 glipizide xl oral tablet extended release 24 hour T1 QL (60 EA per 30 days) 10 mg, 2.5 mg, 5 mg glipizide-metformin hcl oral tablet 2.5-250 mg, T1 2.5-500 mg, 5-500 mg glucagon emergency injection kit 1 mg T1 QL (2 EA per 365 days) glyburide micronized oral tablet 1.5 mg, 3 mg, 6 T1 mg glyburide oral tablet 1.25 mg, 2.5 mg, 5 mg T1 glyburide-metformin oral tablet 1.25-250 mg, 2.5- T1 500 mg, 5-500 mg INVOKAMET ORAL TABLET 150-1000 MG, T1 QL (60 EA per 30 days) 150-500 MG, 50-1000 MG, 50-500 MG INVOKAMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 150-1000 T1 QL (60 EA per 30 days) MG, 150-500 MG, 50-1000 MG, 50-500 MG INVOKANA ORAL TABLET 100 MG, 300 T1 QL (30 EA per 30 days) MG JANUMET ORAL TABLET 50-1000 MG, 50- T1 QL (60 EA per 30 days) 500 MG JANUMET XR ORAL TABLET EXTENDED RELEASE 24 HOUR 100-1000 MG, 50-1000 T1 QL (30 EA per 30 days) MG, 50-500 MG JANUVIA ORAL TABLET 100 MG, 25 MG, T1 QL (30 EA per 30 days) 50 MG JARDIANCE ORAL TABLET 10 MG, 25 MG T1 QL (30 EA per 30 days) LANTUS SOLOSTAR SUBCUTANEOUS T1 SOLUTION PEN-INJECTOR 100 UNIT/ML

14 Drug Status Notes LANTUS SUBCUTANEOUS SOLUTION 100 T1 UNIT/ML LEVEMIR FLEXTOUCH SUBCUTANEOUS T1 SOLUTION PEN-INJECTOR 100 UNIT/ML LEVEMIR SUBCUTANEOUS SOLUTION T1 100 UNIT/ML metformin hcl er oral tablet extended release 24 T1 hour 500 mg, 750 mg metformin hcl oral tablet 1000 mg, 500 mg, 850 T1 mg nateglinide oral tablet 120 mg, 60 mg T1 QL (90 EA per 30 days) NOVOLIN 70/30 FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN- T1 INJECTOR (70-30) 100 UNIT/ML NOVOLIN 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN- T1 INJECTOR (70-30) 100 UNIT/ML NOVOLIN 70/30 RELION SUBCUTANEOUS T1 SUSPENSION (70-30) 100 UNIT/ML NOVOLIN 70/30 SUBCUTANEOUS T1 SUSPENSION (70-30) 100 UNIT/ML NOVOLIN N FLEXPEN SUSPENSION PEN- INJECTOR 100 UNIT/ML SUBCUTANEOUS T1 100 UNIT/ML NOVOLIN N RELION SUBCUTANEOUS T1 SUSPENSION 100 UNIT/ML NOVOLIN N SUBCUTANEOUS T1 SUSPENSION 100 UNIT/ML NOVOLIN R FLEXPEN SOLUTION PEN- INJECTOR 100 UNIT/ML INJECTION 100 T1 UNIT/ML NOVOLIN R INJECTION SOLUTION 100 T1 UNIT/ML NOVOLIN R RELION INJECTION T1 SOLUTION 100 UNIT/ML NOVOLOG 70/30 FLEXPEN RELION SUBCUTANEOUS SUSPENSION PEN- T1 INJECTOR (70-30) 100 UNIT/ML NOVOLOG FLEXPEN RELION SUBCUTANEOUS SOLUTION PEN- T1 INJECTOR 100 UNIT/ML NOVOLOG FLEXPEN SUBCUTANEOUS T1 SOLUTION PEN-INJECTOR 100 UNIT/ML

15 Drug Status Notes NOVOLOG MIX 70/30 FLEXPEN SUBCUTANEOUS SUSPENSION PEN- T1 INJECTOR (70-30) 100 UNIT/ML NOVOLOG MIX 70/30 RELION SUBCUTANEOUS SUSPENSION (70-30) 100 T1 UNIT/ML NOVOLOG MIX 70/30 SUBCUTANEOUS T1 SUSPENSION (70-30) 100 UNIT/ML NOVOLOG RELION SUBCUTANEOUS T1 SOLUTION 100 UNIT/ML NOVOLOG SUBCUTANEOUS SOLUTION T1 100 UNIT/ML OZEMPIC (0.25 OR 0.5 MG/DOSE) SUBCUTANEOUS SOLUTION PEN- T1 QL (1.5 ML per 30 days) INJECTOR 2 MG/1.5ML OZEMPIC (1 MG/DOSE) SUBCUTANEOUS SOLUTION PEN-INJECTOR 2 MG/1.5ML, 4 T1 QL (3 ML per 30 days) MG/3ML pioglitazone hcl oral tablet 15 mg, 30 mg, 45 mg T1 QL (30 EA per 30 days) pioglitazone hcl-metformin hcl oral tablet 15-500 T1 QL (60 EA per 30 days) mg, 15-850 mg RYBELSUS ORAL TABLET 14 MG, 3 MG, 7 T1 QL (30 EA per 30 days) MG SYNJARDY ORAL TABLET 12.5-1000 MG, T1 QL (60 EA per 30 days) 12.5-500 MG, 5-1000 MG, 5-500 MG SYNJARDY XR ORAL TABLET EXTENDED RELEASE 24 HOUR 10-1000 T1 QL (60 EA per 30 days) MG, 12.5-1000 MG, 25-1000 MG, 5-1000 MG TOUJEO SOLOSTAR SUBCUTANEOUS T1 SOLUTION PEN-INJECTOR 300 UNIT/ML TRESIBA FLEXTOUCH SUBCUTANEOUS SOLUTION PEN-INJECTOR 100 UNIT/ML, T1 200 UNIT/ML TRESIBA SOLUTION 100 UNIT/ML T1 SUBCUTANEOUS 100 UNIT/ML VICTOZA SUBCUTANEOUS SOLUTION T1 QL (9 ML per 30 days) PEN-INJECTOR 18 MG/3ML *Antidiarrheal/Probiotic Agents* acidophilus/citrus pectin oral tablet T1 acidophilus/pectin oral capsule T1 bismuth oral tablet chewable 262 mg T1 CULTURELLE DIGESTIVE HEALTH T1 ORAL CAPSULE

16 Drug Status Notes CULTURELLE DIGESTIVE HEALTH T1 ORAL TABLET CHEWABLE diphenoxylate-atropine oral liquid 2.5-0.025 T1 mg/5ml diphenoxylate-atropine oral tablet 2.5-0.025 mg T1 loperamide hcl oral capsule 2 mg T1 loperamide hcl oral liquid 1 mg/5ml T1 loperamide hcl oral suspension 1 mg/7.5ml T1 loperamide hcl oral tablet 2 mg T1 pink bismuth maximum strength oral suspension T1 525 mg/15ml pink bismuth oral suspension 262 mg/15ml T1 probiotic-prebiotic oral capsule 1-250 billion-mg T1 ra pink bismuth oral tablet 262 mg T1 ra probiotic digestive care oral capsule T1 *Antidotes And Specific Antagonists* CHEMET ORAL CAPSULE 100 MG T1 KLOXXADO NASAL LIQUID 8 MG/0.1ML T1 naloxone hcl injection solution 0.4 mg/ml T1 QL (2 ML per 90 days) naloxone hcl injection solution cartridge 0.4 T1 QL (2 ML per 90 days) mg/ml naltrexone hcl oral tablet 50 mg T1 NARCAN NASAL LIQUID 4 MG/0.1ML T1 *Antiemetics* dimenhydrinate injection solution 50 mg/ml T1 dimenhydrinate oral tablet 50 mg T1 DRAMAMINE ORAL TABLET CHEWABLE T1 50 MG dronabinol oral capsule 10 mg, 2.5 mg, 5 mg T1 PA granisetron hcl oral tablet 1 mg T1 QL (10 EA per 30 days) meclizine hcl oral tablet 12.5 mg, 25 mg T1 meclizine hcl oral tablet chewable 25 mg T1 meclizine hcl powder T1 ondansetron hcl oral solution 4 mg/5ml T1 QL (50 ML per 30 days) ondansetron hcl oral tablet 4 mg, 8 mg T1 ondansetron oral tablet dispersible 4 mg, 8 mg T1 trimethobenzamide hcl oral capsule 300 mg T1

17 Drug Status Notes *Antifungals* fluconazole oral suspension reconstituted 10 T1 mg/ml fluconazole oral suspension reconstituted 40 T1 QL (105 ML per 30 days) mg/ml fluconazole oral tablet 100 mg, 50 mg T1 fluconazole oral tablet 150 mg T1 QL (4 EA per 30 days) fluconazole oral tablet 200 mg T1 QL (30 EA per 30 days) griseofulvin microsize oral suspension 125 T1 mg/5ml griseofulvin microsize oral tablet 500 mg T1 griseofulvin ultramicrosize oral tablet 125 mg, T1 250 mg itraconazole oral capsule 100 mg T1 ketoconazole oral tablet 200 mg T1 nystatin oral powder T1 nystatin oral tablet 500000 unit T1 terbinafine hcl oral tablet 250 mg T1 *Antihistamines* aler-dryl oral tablet 50 mg T1 PA aller-chlor oral syrup 2 mg/5ml T1 cetirizine hcl oral syrup 5 mg/5ml T1 cetirizine hcl oral tablet 10 mg, 5 mg T1 chlorpheniramine maleate er oral tablet extended T1 release 12 mg chlorpheniramine maleate oral tablet 4 mg T1 chlorpheniramine maleate powder T1 CLARITIN CHILDRENS ORAL TABLET T1 CHEWABLE 5 MG clemastine fumarate oral syrup 0.67 mg/5ml T1 clemastine fumarate oral tablet 1.34 mg, 2.68 mg T1 cvs allergy childrens oral tablet chewable 12.5 T1 PA mg cyproheptadine hcl oral syrup 2 mg/5ml T1 cyproheptadine hcl oral tablet 4 mg T1 dexchlorpheniramine maleate oral syrup 2 T1 mg/5ml diphenhist oral liquid 12.5 mg/5ml T1 PA diphenhydramine hcl oral capsule 25 mg, 50 mg T1 PA diphenhydramine hcl oral elixir 12.5 mg/5ml T1 PA

18 Drug Status Notes diphenhydramine hcl oral tablet 25 mg T1 PA ED CHLORPED ORAL LIQUID 2 MG/ML T1 fexofenadine hcl childrens oral suspension 30 T1 mg/5ml fexofenadine hcl oral tablet 180 mg T1 levocetirizine dihydrochloride oral tablet 5 mg T1 QL (30 EA per 30 days) loratadine allergy relief oral tablet dispersible 10 T1 mg loratadine childrens oral solution 5 mg/5ml T1 loratadine oral tablet 10 mg T1 promethazine hcl oral solution 6.25 mg/5ml T1 promethazine hcl oral tablet 12.5 mg, 25 mg, 50 T1 mg promethazine hcl rectal suppository 12.5 mg, 25 T1 QL (12 EA per 30 days) mg, 50 mg ra allergy relief childrens oral tablet dispersible T1 PA 12.5 mg silphen cough oral syrup 12.5 mg/5ml T1 PA TRIAMINIC COUGH/RUNNY NOSE ORAL T1 STRIP 12.5 MG *Antihyperlipidemics* atorvastatin calcium oral tablet 10 mg, 20 mg, 40 T1 QL (30 EA per 30 days) mg, 80 mg cholestyramine light oral powder 4 gm/dose T1 cholestyramine oral powder 4 gm/dose T1 colestipol hcl oral granules 5 gm T1 colestipol hcl oral tablet 1 gm T1 ezetimibe oral tablet 10 mg T1 QL (30 EA per 30 days) fenofibrate micronized oral capsule 134 mg, 200 T1 mg, 67 mg fenofibrate oral tablet 145 mg, 48 mg T1 fenofibrate oral tablet 160 mg, 54 mg T1 QL (30 EA per 30 days) gemfibrozil oral tablet 600 mg T1 lovastatin oral tablet 10 mg, 20 mg, 40 mg T1 NIACOR ORAL TABLET 500 MG T1 PRALUENT SUBCUTANEOUS SOLUTION T1 PA; QL (2 ML per 28 days) AUTO-INJECTOR 150 MG/ML, 75 MG/ML pravastatin sodium oral tablet 10 mg, 20 mg, 40 T1 mg, 80 mg

19 Drug Status Notes REPATHA PUSHTRONEX SYSTEM SUBCUTANEOUS SOLUTION CARTRIDGE T1 PA; QL (3.5 ML per 30 days) 420 MG/3.5ML REPATHA SUBCUTANEOUS SOLUTION T1 PA; QL (2 ML per 28 days) PREFILLED SYRINGE 140 MG/ML REPATHA SURECLICK SUBCUTANEOUS T1 PA; QL (2 ML per 28 days) SOLUTION AUTO-INJECTOR 140 MG/ML rosuvastatin calcium oral tablet 10 mg, 20 mg, 40 T1 mg, 5 mg simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg T1 simvastatin oral tablet 80 mg T1 QL (30 EA per 30 days) *Antihypertensives* amlodipine besy-benazepril hcl oral capsule 10- 20 mg, 10-40 mg, 2.5-10 mg, 5-10 mg, 5-20 mg, T1 5-40 mg amlodipine besylate-valsartan oral tablet 10-160 T1 QL (30 EA per 30 days) mg, 10-320 mg, 5-160 mg, 5-320 mg amlodipine-olmesartan oral tablet 10-20 mg, 10- T1 PA; QL (30 EA per 30 days) 40 mg, 5-20 mg, 5-40 mg atenolol-chlorthalidone oral tablet 100-25 mg, T1 50-25 mg benazepril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 T1 mg benazepril-hydrochlorothiazide oral tablet 10- T1 12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg bisoprolol-hydrochlorothiazide oral tablet 10- T1 6.25 mg, 2.5-6.25 mg, 5-6.25 mg captopril oral tablet 100 mg T1 captopril oral tablet 12.5 mg, 25 mg, 50 mg T1 QL (90 EA per 30 days) captopril-hydrochlorothiazide oral tablet 25-15 T1 mg, 25-25 mg, 50-15 mg, 50-25 mg clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg T1 doxazosin mesylate oral tablet 1 mg, 2 mg, 4 mg, T1 8 mg enalapril maleate oral tablet 10 mg, 2.5 mg, 20 T1 mg, 5 mg enalapril-hydrochlorothiazide oral tablet 10-25 T1 mg, 5-12.5 mg fosinopril sodium oral tablet 10 mg, 20 mg, 40 mg T1 fosinopril sodium-hctz oral tablet 10-12.5 mg, 20- T1 12.5 mg guanfacine hcl oral tablet 1 mg, 2 mg T1

20 Drug Status Notes hydralazine hcl oral tablet 10 mg, 100 mg, 25 mg, T1 50 mg irbesartan oral tablet 150 mg, 300 mg, 75 mg T1 QL (30 EA per 30 days) irbesartan-hydrochlorothiazide oral tablet 150- T1 QL (30 EA per 30 days) 12.5 mg, 300-12.5 mg lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 T1 mg, 40 mg, 5 mg lisinopril-hydrochlorothiazide oral tablet 10-12.5 T1 mg, 20-12.5 mg, 20-25 mg losartan potassium oral tablet 100 mg, 25 mg, 50 T1 mg losartan potassium-hctz oral tablet 100-12.5 mg, T1 100-25 mg, 50-12.5 mg methyldopa oral tablet 250 mg, 500 mg T1 metoprolol-hydrochlorothiazide oral tablet 100- T1 25 mg, 100-50 mg, 50-25 mg minoxidil oral tablet 10 mg, 2.5 mg T1 moexipril hcl oral tablet 15 mg, 7.5 mg T1 olmesartan medoxomil oral tablet 20 mg, 40 mg, T1 5 mg olmesartan medoxomil-hctz oral tablet 20-12.5 T1 QL (60 EA per 30 days) mg, 40-12.5 mg, 40-25 mg perindopril erbumine oral tablet 2 mg, 4 mg, 8 T1 mg prazosin hcl oral capsule 1 mg, 2 mg, 5 mg T1 propranolol-hctz oral tablet 40-25 mg, 80-25 mg T1 QL (60 EA per 30 days) quinapril hcl oral tablet 10 mg, 20 mg, 40 mg, 5 T1 mg quinapril-hydrochlorothiazide oral tablet 10-12.5 T1 QL (30 EA per 30 days) mg, 20-12.5 mg, 20-25 mg ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 T1 mg telmisartan oral tablet 20 mg, 40 mg, 80 mg T1 terazosin hcl oral capsule 1 mg, 10 mg, 2 mg, 5 T1 mg trandolapril oral tablet 1 mg, 2 mg, 4 mg T1 valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 T1 mg valsartan-hydrochlorothiazide oral tablet 160- 12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, T1 80-12.5 mg

21 Drug Status Notes *Anti-Infective Agents - Misc.* atovaquone oral suspension 750 mg/5ml T1 QL (210 ML per 18 days) clindamycin hcl oral capsule 150 mg, 300 mg, 75 T1 mg clindamycin palmitate hcl oral solution T1 reconstituted 75 mg/5ml dapsone oral tablet 100 mg, 25 mg T1 DORIBAX INTRAVENOUS SOLUTION T1 RECONSTITUTED 250 MG, 500 MG FIRST-VANCOMYCIN 25 ORAL T1 SOLUTION 25 MG/ML FIRST-VANCOMYCIN 50 ORAL T1 SOLUTION 50 MG/ML FIRVANQ ORAL SOLUTION T1 RECONSTITUTED 25 MG/ML, 50 MG/ML linezolid oral tablet 600 mg T1 QL (28 EA per 14 days) methenamine hippurate oral tablet 1 gm T1 methenamine mandelate oral tablet 0.5 gm, 1 gm T1 metronidazole oral tablet 250 mg, 500 mg T1 nitrofurantoin macrocrystal oral capsule 100 mg, T1 QL (60 EA per 30 days) 50 mg nitrofurantoin macrocrystal oral capsule 25 mg T1 nitrofurantoin monohyd macro oral capsule 100 T1 QL (60 EA per 30 days) mg nitrofurantoin oral suspension 25 mg/5ml T1 AL (Max 12 Years) PRIMSOL ORAL SOLUTION 50 MG/5ML T1 QL (600 ML per 30 days) sulfamethoxazole-trimethoprim oral suspension T1 200-40 mg/5ml sulfamethoxazole-trimethoprim oral tablet 400-80 T1 mg, 800-160 mg tinidazole oral tablet 500 mg T1 trimethoprim oral tablet 100 mg T1 QL (60 EA per 30 days) vancomycin hcl intravenous solution reconstituted T1 10 gm, 1000 mg, 500 mg, 5000 mg, 750 mg *Antimalarials* chloroquine phosphate oral tablet 250 mg T1 PA hydroxychloroquine sulfate oral tablet 200 mg T1 mefloquine hcl oral tablet 250 mg T1 QL (5 EA per 30 days) primaquine phosphate oral tablet 26.3 mg T1 QL (14 EA per 30 days) quinine sulfate oral capsule 324 mg T1

22 Drug Status Notes *Antimycobacterial Agents* ethambutol hcl oral tablet 100 mg, 400 mg T1 isoniazid oral syrup 50 mg/5ml T1 isoniazid oral tablet 100 mg, 300 mg T1 pyrazinamide oral tablet 500 mg T1 rifampin oral capsule 150 mg, 300 mg T1 RIFATER ORAL TABLET 50-120-300 MG T1 TRECATOR ORAL TABLET 250 MG T1 *Antineoplastics And Adjunctive Therapies* anastrozole oral tablet 1 mg T1 GR-F bicalutamide oral tablet 50 mg T1 capecitabine oral tablet 150 mg, 500 mg T1 PA cyclophosphamide oral capsule 25 mg, 50 mg T1 cyclophosphamide oral tablet 25 mg, 50 mg T1 ELIGARD SUBCUTANEOUS KIT 22.5 MG, T1 PA 45 MG ELIGARD SUBCUTANEOUS KIT 30 MG, T1 7.5 MG ERLEADA ORAL TABLET 60 MG T1 PA flutamide oral capsule 125 mg T1 PA GLEOSTINE ORAL CAPSULE 10 MG, 100 T1 PA MG, 40 MG HEXALEN ORAL CAPSULE 50 MG T1 PA hydroxyurea oral capsule 500 mg T1 imatinib mesylate oral tablet 100 mg, 400 mg T1 PA INTRON A INJECTION SOLUTION T1 PA 10000000 UNIT/ML, 6000000 UNIT/ML INTRON A INJECTION SOLUTION RECONSTITUTED 10000000 UNIT, T1 PA 18000000 UNIT, 50000000 UNIT letrozole oral tablet 2.5 mg T1 QL (30 EA per 30 days) leucovorin calcium oral tablet 10 mg, 15 mg, 25 T1 mg, 5 mg LEUKERAN ORAL TABLET 2 MG T1 LUPRON DEPOT (1-MONTH) T1 PA INTRAMUSCULAR KIT 3.75 MG, 7.5 MG LUPRON DEPOT (3-MONTH) T1 PA INTRAMUSCULAR KIT 11.25 MG, 22.5 MG

23 Drug Status Notes LUPRON DEPOT (4-MONTH) T1 PA INTRAMUSCULAR KIT 30 MG MATULANE ORAL CAPSULE 50 MG T1 PA megestrol acetate oral suspension 40 mg/ml, 400 T1 mg/10ml megestrol acetate oral tablet 20 mg, 40 mg T1 mercaptopurine oral tablet 50 mg T1 methotrexate oral tablet 2.5 mg T1 methotrexate sodium (pf) injection solution 50 T1 mg/2ml methotrexate sodium injection solution 50 mg/2ml T1 MYLERAN ORAL TABLET 2 MG T1 TABLOID ORAL TABLET 40 MG T1 tamoxifen citrate oral tablet 10 mg, 20 mg T1 GR-F; AL (Min 35 Years) tretinoin oral capsule 10 mg T1 PA *Antiparkinson And Related Therapy Agents* amantadine hcl oral capsule 100 mg T1 amantadine hcl oral syrup 50 mg/5ml T1 amantadine hcl oral tablet 100 mg T1 benztropine mesylate oral tablet 0.5 mg, 1 mg, 2 T1 mg bromocriptine mesylate oral capsule 5 mg T1 bromocriptine mesylate oral tablet 2.5 mg T1 carbidopa oral tablet 25 mg T1 carbidopa-levodopa er oral tablet extended T1 release 25-100 mg, 50-200 mg carbidopa-levodopa oral tablet 10-100 mg, 25- T1 100 mg, 25-250 mg entacapone oral tablet 200 mg T1 pramipexole dihydrochloride oral tablet 0.125 T1 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg ropinirole hcl oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 T1 mg, 3 mg, 4 mg, 5 mg selegiline hcl oral capsule 5 mg T1 trihexyphenidyl hcl oral tablet 2 mg, 5 mg T1 *Antipsychotics/Antimanic Agents* aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 T1 QL (30 EA per 30 days) mg, 30 mg, 5 mg

24 Drug Status Notes clozapine oral tablet 100 mg, 200 mg, 25 mg, 50 T1 mg fluphenazine hcl injection solution 2.5 mg/ml T1 fluphenazine hcl oral concentrate 5 mg/ml T1 fluphenazine hcl oral elixir 2.5 mg/5ml T1 fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, T1 5 mg haloperidol decanoate intramuscular solution T1 100 mg/ml haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 T1 mg, 20 mg, 5 mg lithium carbonate er oral tablet extended release T1 300 mg, 450 mg lithium carbonate oral capsule 150 mg, 300 mg, T1 600 mg lithium carbonate oral tablet 300 mg T1 loxapine succinate oral capsule 10 mg, 25 mg, 5 T1 mg, 50 mg olanzapine oral tablet 10 mg, 15 mg, 2.5 mg, 20 T1 mg, 5 mg, 7.5 mg olanzapine oral tablet dispersible 10 mg, 15 mg, T1 AL (Max 10 Years) 20 mg, 5 mg perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg T1 prochlorperazine maleate oral tablet 10 mg, 5 mg T1 prochlorperazine rectal suppository 25 mg T1 QL (60 EA per 30 days) quetiapine fumarate er oral tablet extended T1 ST; QL (30 EA per 30 days) release 24 hour 150 mg, 200 mg, 50 mg quetiapine fumarate er oral tablet extended T1 ST; QL (60 EA per 30 days) release 24 hour 300 mg, 400 mg quetiapine fumarate oral tablet 100 mg, 200 mg, T1 25 mg, 300 mg, 400 mg, 50 mg risperidone oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 T1 mg, 3 mg, 4 mg thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg T1 trifluoperazine hcl oral tablet 1 mg, 10 mg, 2 mg, T1 5 mg ziprasidone hcl oral capsule 20 mg, 40 mg, 60 T1 mg, 80 mg *Antiseptics & Disinfectants* povidone-iodine external pad 10 % T1 povidone-iodine external solution 10 % T1

25 Drug Status Notes *Antivirals* abacavir sulfate oral solution 20 mg/ml T1 QL (900 ML per 30 days) abacavir sulfate oral tablet 300 mg T1 QL (60 EA per 30 days) abacavir sulfate-lamivudine oral tablet 600-300 T1 QL (30 EA per 30 days) mg abacavir-lamivudine-zidovudine oral tablet 300- T1 QL (60 EA per 30 days) 150-300 mg acyclovir oral capsule 200 mg T1 acyclovir oral suspension 200 mg/5ml T1 AL (Max 12 Years) acyclovir oral tablet 400 mg, 800 mg T1 APTIVUS ORAL CAPSULE 250 MG T1 QL (120 EA per 30 days) APTIVUS ORAL SOLUTION 100 MG/ML T1 QL (300 ML per 30 days) atazanavir sulfate oral capsule 150 mg, 200 mg T1 QL (60 EA per 30 days) atazanavir sulfate oral capsule 300 mg T1 QL (30 EA per 30 days) BIKTARVY ORAL TABLET 50-200-25 MG T1 QL (30 EA per 30 days) COMPLERA ORAL TABLET 200-25-300 T1 QL (30 EA per 30 days) MG CRIXIVAN ORAL CAPSULE 200 MG T1 QL (360 EA per 30 days) CRIXIVAN ORAL CAPSULE 400 MG T1 QL (180 EA per 30 days) DESCOVY ORAL TABLET 200-25 MG T1 QL (30 EA per 30 lifetimes) didanosine oral capsule delayed release 125 mg, T1 QL (60 EA per 30 days) 200 mg didanosine oral capsule delayed release 250 mg, T1 QL (30 EA per 30 days) 400 mg EDURANT ORAL TABLET 25 MG T1 QL (30 EA per 30 days) efavirenz oral capsule 200 mg T1 QL (90 EA per 30 days) efavirenz oral capsule 50 mg T1 QL (360 EA per 30 days) efavirenz oral tablet 600 mg T1 QL (30 EA per 30 days) efavirenz-emtricitab-tenofovir oral tablet 600- T1 QL (30 EA per 30 days) 200-300 mg efavirenz-lamivudine-tenofovir oral tablet 400- T1 QL (30 EA per 30 days) 300-300 mg, 600-300-300 mg emtricitabine oral capsule 200 mg T1 QL (30 EA per 30 days) emtricitabine-tenofovir df oral tablet 100-150 mg, T1 QL (30 EA per 30 days) 133-200 mg, 167-250 mg, 200-300 mg EMTRIVA ORAL SOLUTION 10 MG/ML T1 QL (600 ML per 30 days) EPIVIR HBV ORAL SOLUTION 5 MG/ML T1 QL (1800 ML per 30 days) etravirine oral tablet 100 mg T1 QL (120 EA per 30 days) etravirine oral tablet 200 mg T1 QL (60 EA per 30 days) famciclovir oral tablet 125 mg, 250 mg, 500 mg T1 QL (90 EA per 30 days)

26 Drug Status Notes fosamprenavir calcium oral tablet 700 mg T1 QL (120 EA per 30 days) GENVOYA ORAL TABLET 150-150-200-10 T1 QL (30 EA per 30 days) MG INTELENCE ORAL TABLET 25 MG T1 INVIRASE ORAL CAPSULE 200 MG T1 QL (300 EA per 30 days) INVIRASE ORAL TABLET 500 MG T1 QL (120 EA per 30 days) ISENTRESS ORAL TABLET 400 MG T1 QL (60 EA per 30 days) ISENTRESS ORAL TABLET CHEWABLE T1 100 MG, 25 MG JULUCA ORAL TABLET 50-25 MG T1 QL (30 EA per 30 days) lamivudine oral solution 10 mg/ml T1 QL (900 ML per 30 days) lamivudine oral tablet 100 mg T1 lamivudine oral tablet 150 mg T1 QL (60 EA per 30 days) lamivudine oral tablet 300 mg T1 QL (30 EA per 30 days) lamivudine-zidovudine oral tablet 150-300 mg T1 QL (60 EA per 30 days) LEXIVA ORAL SUSPENSION 50 MG/ML T1 QL (360 ML per 60 days) lopinavir-ritonavir oral solution 400-100 mg/5ml T1 QL (450 ML per 30 days) lopinavir-ritonavir oral tablet 100-25 mg, 200-50 T1 mg MAVYRET ORAL TABLET 100-40 MG T1 PA nevirapine er oral tablet extended release 24 hour T1 QL (30 EA per 30 days) 400 mg nevirapine oral suspension 50 mg/5ml T1 QL (1200 ML per 30 days) nevirapine oral tablet 200 mg T1 QL (60 EA per 30 days) NORVIR ORAL CAPSULE 100 MG T1 QL (360 EA per 30 days) NORVIR ORAL SOLUTION 80 MG/ML T1 QL (450 ML per 30 days) ODEFSEY ORAL TABLET 200-25-25 MG T1 QL (30 EA per 30 days) oseltamivir phosphate oral capsule 30 mg, 45 mg, T1 QL (10 EA per 5 days) 75 mg oseltamivir phosphate oral suspension QL (120 ML per 10 days); AL T1 reconstituted 6 mg/ml (Max 12 Years) PEG-INTRON REDIPEN PAK 4 SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 T1 PA MCG/0.5ML, 50 MCG/0.5ML, 80 MCG/0.5ML PEG-INTRON REDIPEN SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 T1 PA MCG/0.5ML, 80 MCG/0.5ML PEGINTRON SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 T1 PA MCG/0.5ML, 80 MCG/0.5ML

27 Drug Status Notes PEG-INTRON SUBCUTANEOUS KIT 120 MCG/0.5ML, 150 MCG/0.5ML, 50 T1 PA MCG/0.5ML, 80 MCG/0.5ML PREZISTA ORAL TABLET 150 MG T1 QL (240 EA per 30 days) PREZISTA ORAL TABLET 600 MG T1 QL (60 EA per 30 days) PREZISTA ORAL TABLET 75 MG T1 QL (480 EA per 30 days) PREZISTA ORAL TABLET 800 MG T1 QL (30 EA per 30 days) RELENZA DISKHALER INHALATION AEROSOL POWDER BREATH T1 QL (20 EA per 5 days) ACTIVATED 5 MG/BLISTER RESCRIPTOR ORAL TABLET 100 MG T1 QL (360 EA per 30 days) RESCRIPTOR ORAL TABLET 200 MG T1 RIBASPHERE ORAL CAPSULE 200 MG T1 PA ribavirin oral capsule 200 mg T1 PA rimantadine hcl oral tablet 100 mg T1 ritonavir oral tablet 100 mg T1 QL (360 EA per 30 days) SELZENTRY ORAL TABLET 150 MG T1 QL (120 EA per 30 days) SELZENTRY ORAL TABLET 300 MG T1 sofosbuvir-velpatasvir tablet 400-100 mg oral T1 PA; QL (28 EA per 28 days) 400-100 mg stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 T1 QL (60 EA per 30 days) mg stavudine oral solution reconstituted 1 mg/ml T1 QL (1200 EA per 30 days) STRIBILD ORAL TABLET 150-150-200-300 T1 QL (30 EA per 30 days) MG tenofovir disoproxil fumarate oral tablet 300 mg T1 QL (30 EA per 30 days) TIVICAY ORAL TABLET 50 MG T1 QL (30 EA per 30 days) TRIUMEQ ORAL TABLET 600-50-300 MG T1 QL (30 EA per 30 days) valacyclovir hcl oral tablet 1 gm, 500 mg T1 VIDEX ORAL SOLUTION T1 QL (603 ML per 30 days) RECONSTITUTED 2 GM, 4 GM VIRACEPT ORAL TABLET 250 MG T1 QL (300 EA per 30 days) VIRACEPT ORAL TABLET 625 MG T1 QL (120 EA per 30 days) VIREAD ORAL TABLET 150 MG, 200 MG, T1 QL (30 EA per 30 days) 250 MG zidovudine oral capsule 100 mg T1 QL (180 EA per 30 days) zidovudine oral syrup 50 mg/5ml T1 QL (1800 ML per 30 days) zidovudine oral tablet 300 mg T1 QL (60 EA per 30 days) *Beta Blockers* acebutolol hcl oral capsule 200 mg, 400 mg T1

28 Drug Status Notes atenolol oral tablet 100 mg, 25 mg, 50 mg T1 bisoprolol fumarate oral tablet 10 mg, 5 mg T1 BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, T1 QL (30 EA per 30 days) 20 MG, 5 MG carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, T1 6.25 mg labetalol hcl oral tablet 100 mg, 200 mg, 300 mg T1 metoprolol succinate er oral tablet extended T1 QL (45 EA per 30 days) release 24 hour 100 mg, 25 mg, 50 mg metoprolol succinate er oral tablet extended T1 QL (60 EA per 30 days) release 24 hour 200 mg metoprolol tartrate oral tablet 100 mg, 25 mg, 50 T1 mg nadolol oral tablet 20 mg, 40 mg, 80 mg T1 pindolol oral tablet 10 mg, 5 mg T1 propranolol hcl er oral capsule extended release T1 24 hour 120 mg, 160 mg, 60 mg, 80 mg propranolol hcl oral solution 20 mg/5ml, 40 T1 mg/5ml propranolol hcl oral tablet 10 mg, 20 mg, 40 mg, T1 60 mg, 80 mg sotalol hcl (af) oral tablet 120 mg, 160 mg, 80 mg T1 sotalol hcl oral tablet 120 mg, 160 mg, 240 mg, T1 80 mg timolol maleate oral tablet 10 mg, 20 mg, 5 mg T1 *Calcium Channel Blockers* amlodipine besylate oral tablet 10 mg, 2.5 mg, 5 T1 QL (30 EA per 30 days) mg CARTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 T1 QL (30 EA per 30 days) MG, 300 MG diltiazem cd oral capsule extended release 24 T1 QL (30 EA per 30 days) hour 120 mg, 180 mg diltiazem hcl er beads oral capsule extended T1 QL (30 EA per 30 days) release 24 hour 420 mg diltiazem hcl er coated beads oral capsule T1 QL (30 EA per 30 days) extended release 24 hour 300 mg diltiazem hcl er oral capsule extended release 12 T1 QL (60 EA per 30 days) hour 120 mg, 60 mg, 90 mg diltiazem hcl er oral capsule extended release 24 T1 QL (30 EA per 30 days) hour 120 mg, 180 mg, 240 mg

29 Drug Status Notes diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, T1 90 mg dilt-xr oral capsule extended release 24 hour 120 T1 QL (30 EA per 30 days) mg, 180 mg, 240 mg felodipine er oral tablet extended release 24 hour T1 QL (30 EA per 30 days) 10 mg, 2.5 mg, 5 mg isradipine oral capsule 2.5 mg, 5 mg T1 nicardipine hcl oral capsule 20 mg, 30 mg T1 nifedipine er oral tablet extended release 24 hour T1 QL (30 EA per 30 days) 30 mg, 60 mg nifedipine er osmotic release oral tablet extended T1 QL (30 EA per 30 days) release 24 hour 30 mg, 60 mg, 90 mg nifedipine oral capsule 10 mg, 20 mg T1 nimodipine oral capsule 30 mg T1 PA TAZTIA XT ORAL CAPSULE EXTENDED RELEASE 24 HOUR 120 MG, 180 MG, 240 T1 QL (30 EA per 30 days) MG, 300 MG, 360 MG verapamil hcl er oral capsule extended release 24 T1 QL (30 EA per 30 days) hour 200 mg, 300 mg verapamil hcl er oral tablet extended release 120 T1 QL (30 EA per 30 days) mg, 180 mg, 240 mg verapamil hcl oral tablet 120 mg, 40 mg, 80 mg T1 *Cardiotonics* digoxin oral tablet 125 mcg, 250 mcg T1 *Cardiovascular Agents - Misc.* ENTRESTO ORAL TABLET 24-26 MG, 49- T1 PA; QL (60 EA per 30 days) 51 MG, 97-103 MG sildenafil citrate oral tablet 20 mg T1 PA *Cephalosporins* cefaclor oral capsule 250 mg, 500 mg T1 cefaclor oral suspension reconstituted 125 T1 AL (Max 11 Years) mg/5ml, 250 mg/5ml, 375 mg/5ml cefadroxil oral capsule 500 mg T1 QL (40 EA per 10 days) cefadroxil oral suspension reconstituted 250 T1 mg/5ml, 500 mg/5ml cefadroxil oral tablet 1 gm T1 QL (20 EA per 10 days) cefdinir oral capsule 300 mg T1 cefdinir oral suspension reconstituted 125 T1 mg/5ml, 250 mg/5ml cefpodoxime proxetil oral suspension T1 reconstituted 100 mg/5ml, 50 mg/5ml

30 Drug Status Notes cefpodoxime proxetil oral tablet 100 mg, 200 mg T1 cefprozil oral suspension reconstituted 125 T1 mg/5ml, 250 mg/5ml cefprozil oral tablet 250 mg, 500 mg T1 CEFTIN ORAL SUSPENSION RECONSTITUTED 125 MG/5ML, 250 T1 AL (Max 11 Years) MG/5ML ceftriaxone sodium injection solution T1 QL (10 EA per 30 days) reconstituted 1 gm, 500 mg ceftriaxone sodium injection solution T1 QL (180 EA per 30 days) reconstituted 250 mg ceftriaxone sodium intravenous solution T1 reconstituted 1 gm cefuroxime axetil oral suspension reconstituted T1 AL (Max 11 Years) 125 mg/5ml cefuroxime axetil oral tablet 250 mg, 500 mg T1 cephalexin oral capsule 250 mg, 500 mg T1 cephalexin oral suspension reconstituted 125 T1 mg/5ml, 250 mg/5ml *Chemicals* acetone solution T1 ACTIPHYTE OF LEMONGRASS LIQUID T1 ammonium lactate solution 70 % T1 benzyl benzoate liquid T1 camphor spirit spirit T1 chlorhexidine gluconate solution T1 chloroform solution T1 cottonseed oil oil T1 CRYOSERV SOLUTION T1 dimethyl sulfoxide solution , 100 % T1 ether solution T1 ethyl alcohol (rubbing) solution 70 % T1 ethyl alcohol external solution 95 % T1 ethyl alcohol solution 95 % T1 eugenol solution T1 glycerin liquid T1 glycerin solution T1 glycerine liquid T1 glycerol formal liquid T1 glycine soya extract solution T1

31 Drug Status Notes glycine soya protein solution T1 gnp alcohol denatured solution T1 gnp peppermint spirit spirit T1 gnp sodium silicate solution T1 guaiacol solution T1 hydroxyprogesterone caproate powder T1 isopropyl alcohol (rubbing) solution 70 % T1 isopropyl alcohol solution , 50 %, 70 %, 91 %, T1 99 % isopropyl palmitate liquid T1 methanol solution , 99 % T1 methyl alcohol solution T1 peppermint spirit spirit T1 pine tar liquid T1 polysorbate 20 solution T1 polysorbate 40 solution T1 polysorbate 60 liquid T1 polysorbate 80 oral liquid T1 PRETZ SOLUTION 10 % T1 ra ethyl alcohol solution 70 % T1 sm camphor spirit spirit T1 sodium bicarbonate powder T1 sodium silicate solution 40 % T1 turpentine liquid T1 undecylenic acid liquid T1 *Contraceptives* ARANELLE ORAL TABLET 0.5/1/0.5-35 T1 QL (28 EA per 28 days) MG-MCG desogestrel-ethinyl estradiol oral tablet 0.15-30 T1 GR-F; QL (28 EA per 21 days) mg-mcg drospirenone-ethinyl estradiol oral tablet 3-0.02 T1 QL (28 EA per 21 days) mg, 3-0.03 mg ELLA ORAL TABLET 30 MG T1 GR-F; QL (1 EA per 30 days) KELNOR 1/35 ORAL TABLET 1-35 MG- T1 GR-F; QL (28 EA per 21 days) MCG levonorgest-eth estrad 91-day oral tablet 0.15- T1 GR-F; QL (91 EA per 91 days) 0.03 mg levonorgestrel oral tablet 0.75 mg T1 GR-F; QL (2 EA per 30 days) levonorgestrel oral tablet 1.5 mg T1 GR-F; QL (1 EA per 30 days)

32 Drug Status Notes levonorgestrel-ethinyl estrad oral tablet 0.1-20 T1 GR-F; QL (28 EA per 21 days) mg-mcg, 0.15-30 mg-mcg levonorgestrel-ethinyl estrad oral tablet 90-20 T1 QL (28 EA per 21 days) mcg LO LOESTRIN FE ORAL TABLET 1 MG-10 T1 PA; QL (28 EA per 21 days) MCG / 10 MCG LOW-OGESTREL ORAL TABLET 0.3-30 T1 GR-F; QL (28 EA per 21 days) MG-MCG medroxyprogesterone acetate intramuscular T1 GR-F; QL (1 ML per 90 days) suspension 150 mg/ml medroxyprogesterone acetate intramuscular T1 QL (1 ML per 90 days) suspension prefilled syringe 150 mg/ml MICROGESTIN 1.5/30 ORAL TABLET 1.5- T1 GR-F; QL (21 EA per 21 days) 30 MG-MCG MICROGESTIN FE 1.5/30 ORAL TABLET T1 GR-F; QL (28 EA per 21 days) 1.5-30 MG-MCG NECON 0.5/35 (28) ORAL TABLET 0.5-35 T1 GR-F; QL (28 EA per 21 days) MG-MCG NECON 1/35 (28) ORAL TABLET 1-35 MG- T1 GR-F; QL (28 EA per 21 days) MCG NECON 1/50 (28) ORAL TABLET 1-50 MG- T1 GR-F; QL (28 EA per 21 days) MCG NECON 10/11 (28) ORAL TABLET 35 MCG T1 GR-F; QL (28 EA per 21 days) NECON 7/7/7 ORAL TABLET 0.5/0.75/1-35 T1 GR-F; QL (28 EA per 21 days) MG-MCG norethin ace-eth estrad-fe oral tablet 1-20 mg- T1 GR-F; QL (28 EA per 21 days) mcg, 1-20 mg-mcg(24) norethindrone acet-ethinyl est oral tablet 1-20 T1 GR-F; QL (21 EA per 21 days) mg-mcg norethindrone oral tablet 0.35 mg T1 GR-F; QL (28 EA per 21 days) norgestimate-eth estradiol oral tablet 0.25-35 mg- T1 GR-F; QL (28 EA per 21 days) mcg OCELLA ORAL TABLET 3-0.03 MG T1 PA; QL (28 EA per 21 days) OGESTREL ORAL TABLET 0.5-50 MG- T1 QL (28 EA per 21 days) MCG SYEDA TABLET 3-0.03 MG ORAL 3-0.03 T1 PA; QL (28 EA per 21 days) MG TRINESSA (28) ORAL TABLET T1 GR-F; QL (28 EA per 21 days) 0.18/0.215/0.25 MG-35 MCG TRINESSA LO ORAL TABLET T1 GR-F; QL (28 EA per 21 days) 0.18/0.215/0.25 MG-25 MCG TRIVORA (28) ORAL TABLET 50-30/75-40/ T1 GR-F; QL (28 EA per 21 days) 125-30 MCG

33 Drug Status Notes TWIRLA TRANSDERMAL PATCH T1 PA; QL (3 EA per 28 days) WEEKLY 120-30 MCG/24HR VELIVET ORAL TABLET 0.1/0.125/0.15 - T1 GR-F; QL (28 EA per 21 days) 0.025 MG ZARAH TABLET 3-0.03 MG ORAL 3-0.03 T1 PA; QL (28 EA per 21 days) MG ZENCHENT ORAL TABLET 0.4-35 MG- T1 GR-F; QL (28 EA per 21 days) MCG ZOVIA 1/50E (28) ORAL TABLET 1-50 MG- T1 GR-F; QL (28 EA per 21 days) MCG ZUMANDIMINE ORAL TABLET 3-0.03 MG T1 PA; QL (28 EA per 21 days) *Corticosteroids* cortisone acetate oral tablet 25 mg T1 DEXAMETHASONE INTENSOL ORAL T1 CONCENTRATE 1 MG/ML dexamethasone oral elixir 0.5 mg/5ml T1 dexamethasone oral solution 0.5 mg/5ml T1 dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, T1 1.5 mg, 2 mg, 4 mg, 6 mg dexamethasone oral tablet therapy pack 1.5 mg T1 (21), 1.5 mg (35), 1.5 mg (51) fludrocortisone acetate oral tablet 0.1 mg T1 hydrocortisone oral tablet 10 mg, 20 mg, 5 mg T1 methylprednisolone oral tablet 16 mg, 32 mg, 4 T1 mg, 8 mg methylprednisolone oral tablet therapy pack 4 mg T1 prednisolone oral solution 15 mg/5ml T1 prednisolone sodium phosphate oral solution 15 T1 mg/5ml, 6.7 (5 base) mg/5ml prednisone oral solution 5 mg/5ml T1 prednisone oral tablet 1 mg, 10 mg, 2.5 mg, 20 T1 mg, 5 mg, 50 mg prednisone oral tablet therapy pack 10 mg (21), T1 10 mg (48), 5 mg (21), 5 mg (48) *Cough/Cold/Allergy* ACETA-GESIC ORAL TABLET 12.5-325 T1 MG acetylcysteine inhalation solution 10 %, 20 % T1 ADVIL ALLERGY & CONGESTION ORAL T1 TABLET 4-10-200 MG ADVIL ALLERGY SINUS ORAL TABLET 2- T1 30-200 MG 34 Drug Status Notes ADVIL COLD & SINUS LIQUI-GELS ORAL T1 CAPSULE 30-200 MG ALA-HIST PE ORAL TABLET 2-10 MG T1 ALKA-SELTZER PLS ALLERGY & CGH T1 ORAL CAPSULE 5-6.25-10-325 MG ALKA-SELTZER PLUS COLD & COUGH T1 ORAL CAPSULE 5-2-10-325 MG ALKA-SELTZER PLUS COLD & COUGH ORAL TABLET EFFERVESCENT 7.8-2-10- T1 325 MG ALKA-SELTZER PLUS COLD & FLU ORAL TABLET EFFERVESCENT 5-2-10- T1 250 MG ALKA-SELTZER PLUS DAY/NIGHT ORAL T1 ALKA-SELTZER PLUS NIGHT COLD ORAL TABLET EFFERVESCENT 7.8-6.25- T1 10-500 MG ALKA-SELTZER PLUS SINUS ORAL T1 TABLET EFFERVESCENT 7.8-325 MG all day pain relf sinus/cold d oral tablet extended T1 release 12 hour 120-220 mg allergy multi-symptom day/nght oral T1 aller-time oral tablet 2.5-60 mg T1 ambi 12.5cpd/100gfn/30pse oral liquid 30-12.5- T1 100 mg/5ml ambi 12.5cpd/1dcpm/30pse oral liquid 30-1-12.5 T1 mg/5ml ap-hist dm oral liquid 7.5-4-15 mg/5ml T1 benzonatate oral capsule 100 mg, 200 mg T1 biobron sf oral syrup 10-15-350 mg/5ml T1 biodesp dm oral syrup 5-15-100 mg/5ml T1 biogtuss oral liquid 10-15-300 mg/5ml T1 bionatuss dxp oral liquid 10-2-20 mg/5ml T1 bionel oral liquid 30-15-200 mg/5ml T1 bionel pediatric oral liquid 15-5-50 mg/5ml T1 biospec dmx oral liquid 15-25 mg/5ml T1 bpm-dm-phen oral syrup 5-2-10 mg/5ml T1 bronchial asthma relief oral tablet 12.5-200 mg T1 BRONCOTRON PED DROPS ORAL T1 LIQUID 2.5-5-100 MG/ML BRONCOTRON PED ORAL LIQUID 10-15- T1 350 MG/5ML

35 Drug Status Notes BRONCOTRON-S ORAL LIQUID 20-400 T1 MG/5ML BRONKAID ORAL TABLET 25-400 MG T1 bronkids oral liquid 1.5-0.6-2.75 mg/ml, 10-4-10 T1 mg/5ml brotapp dm oral liquid 15-1-5 mg/5ml T1 capcof oral syrup 5-2-10 mg/5ml T1 QL (240 ML per 30 days) capmist dm oral tablet 60-15-400 mg T1 capron dm oral liquid 7.5-7.5 mg/5ml T1 CARBAPHEN CH ORAL SUSPENSION 10- T1 4-24 MG/5ML CARBAPHEN PED CH ORAL SUSPENSION T1 2.5-1.25-8 MG/ML CCP CAFFEINE FREE ORAL TABLET 325- T1 200-10 MG CERTUSS-D ORAL TABLET 60-25-400 MG T1 cetirizine-pseudoephedrine er oral tablet T1 extended release 12 hour 5-120 mg cheratussin ac oral syrup 100-10 mg/5ml T1 chest congestion daytime oral tablet 325-200 mg T1 chest congestion relief pe oral tablet 10-400 mg T1 chest congestion/pain & sinus oral tablet 10-650- T1 400 mg childrens cough oral liquid 5-100 mg/5ml T1 childrens cough/runny nose oral suspension 5- T1 160-1 mg/5ml childrens plus cold & allergy oral suspension T1 12.5-2.5-160 mg/5ml childrens plus cold oral suspension 1-2.5-160 T1 mg/5ml childrens plus flu oral suspension 2.5-1-5-160 T1 mg/5ml chlo tuss ex oral liquid 12.5-100 mg/5ml T1 CHLO TUSS ORAL LIQUID 30-1-12.5 T1 MG/5ML chlophed oral liquid 5-12.5-100 mg/5ml T1 codituss dm oral syrup 5-8.33-10 mg/5ml T1 cold & cough childrens oral elixir 2.5-1-5 mg/5ml T1 cold & cough day/night child oral 2.5-5 &2.5- T1 6.25 mg/5ml cold & cough daytime oral liquid 1000-30 T1 mg/30ml 36 Drug Status Notes cold & flu nighttime/daytime oral (liquid) T1 cold & flu relief nighttime d oral liquid 60-12.5- T1 30-1000 mg/30ml cold & flu severe daytime oral tablet 5-10-200- T1 325 mg cold control pe cold/flu med oral tablet 25-10-650 T1 mg cold head congestion daytime oral tablet 10-5- T1 325 mg cold head congestion nighttime oral tablet 5-2- T1 10-325 mg cold multi-symptom day/night oral 5-2-10-325 mg T1 cold multi-symptom warm night oral liquid 5- T1 6.25-10-325 mg/15ml cold relief plus oral tablet effervescent 2-7.8-325 T1 mg cold/flu relief day/night oral T1 cold/flu relief nighttime oral liquid 15-6.25-325 T1 mg/15ml cold/flu relief oral liquid 10-5-325 mg/15ml T1 complete sinus relief oral tablet 2-10-500 mg T1 CONEX COLD/ALLERGY ORAL T1 SOLUTION 1-30 MG/5ML CONEX COLD/ALLERGY ORAL TABLET T1 2-60 MG CONTAC COLD+FLU MAX ST ORAL T1 TABLET 2-5-500 MG CORICIDIN HBP CONGESTION/COUGH T1 ORAL CAPSULE 10-200 MG CORICIDIN HBP DAY/NIGHT COLD T1 ORAL 10-20 &15-200-2 MG CORICIDIN NIGHTTIME COLD-COUGH T1 ORAL LIQUID 12.5-325 MG/15ML cough & cold oral tablet 4-30 mg T1 cough & sore throat nighttime oral liquid 30- T1 12.5-1000 mg/30ml cough daytime/nighttime oral liquid therapy pack T1 6.25-15 & 15 mg/15ml cvs cough & sore throat child oral liquid 160-5 T1 mg/5ml cvs non-drying sinus pe oral tablet 5-200 mg T1 DALLERGY ORAL LIQUID 1-2.5 MG/ML T1

37 Drug Status Notes DALLERGY ORAL TABLET 1-5 MG T1 day time pe cold/flu relief oral capsule 10-5-325 T1 mg daytime cold & cough childrens oral solution 2.5- T1 5 mg/5ml DAYTIME COLD MEDICINE ORAL T1 LIQUID 325-15 MG/15ML DELSYM CGH/CLD NIGHTTIME CHILD T1 ORAL LIQUID 12.5-5-325 MG/10ML DELTUSS DMX ORAL LIQUID 30-1-15 T1 MG/5ML DELTUSS DP ORAL LIQUID 1-30 MG/5ML T1 DESGEN DM ORAL SYRUP 5-15-100 T1 MG/5ML DESGEN PEDIATRIC ORAL LIQUID 2.5-5- T1 50 MG/ML despec dm oral syrup 5-10-100 mg/5ml T1 despec-dm oral tablet 40-30-400 mg T1 dextromethorphan-guaifenesin oral solution 10- T1 100 mg/5ml DIABETIC TUSSIN COLD & FLU ORAL T1 LIQUID 10-12.5-325 MG/5ML DIABETIC TUSSIN NIGHT COLD/FLU T1 ORAL LIQUID 10-12.5-325 MG/5ML DIMETAPP LONG ACT COUGH/COLD T1 ORAL SYRUP 1-7.5 MG/5ML DOLOGEN ORAL TABLET 2-650 MG T1 dometuss-da/children oral liquid 1-2.5 mg/5ml T1 dometuss-dmx oral liquid 10-30-200 mg/5ml T1 doxylamine-phenylephrine oral tablet 7.5-10 mg T1 dr manzanilla pe oral liquid 2.5-10 mg/5ml T1 DURAVENT PE ORAL TABLET 10-395 MG T1 ed bron gp oral liquid 5-100 mg/5ml T1 ED CHLORPED D ORAL LIQUID 2-5 T1 MG/ML ed-a-hist dm oral liquid 10-4-15 mg/5ml T1 ENDACOF-DM ORAL LIQUID 2.5-1-5 T1 MG/5ML ENDACON ORAL SYRUP 10-20-100 T1 MG/5ML ENTEX LQ ORAL LIQUID 10-100 MG/5ML T1 ENTEX T ORAL TABLET 60-375 MG T1 38 Drug Status Notes entre-cough oral liquid 30-15-175 mg/5ml T1 eq allergy/sinus headache oral tablet 12.5-30-500 T1 mg eq childrens cold oral liquid 1-15-160 mg/5ml T1 eq cold plus oral capsule 2-30-325 mg T1 eq cold relief complete oral tablet 30-2-15-325 T1 mg eq cold/cough plus oral capsule 30-2-10-325 mg T1 eq daytime cold/flu relief oral capsule 30-325-15 T1 mg eq daytime cold/flu relief oral liquid 30-325-15 T1 mg/15ml eq flu & severe cold & cough oral packet 25-10- T1 650 mg eq flu relief oral tablet 30-500-15 mg T1 eq flu/severe cold/congestion oral packet 60-4- T1 30-1000 mg eq night time cold & cough oral liquid 6.25-2.5 T1 mg/5ml eq nite time cold/flu relief oral capsule 30-6.25- T1 15-325 mg eq nitetime cold/flu ms relief oral capsule 15- T1 6.25-325 mg eq non-drying sinus oral capsule 30-200 mg T1 eq sinus congestion & pain oral tablet 5-325-200 T1 mg eq triacting cold/allergy oral syrup 1-15 mg/5ml T1 eql congestion relief oral tablet 10-200 mg T1 FENESIN DM IR ORAL TABLET 15-400 MG T1 flu & sore throat oral packet 20-10-650 mg T1 flu/severe cold & cough day oral packet 20-10- T1 650 mg GENCONTUSS ORAL LIQUID 5-2-10 T1 MG/5ML G-P-TUSS DXP ORAL LIQUID 10-2-20 T1 MG/5ML G-TRON PEDIATRIC DROPS ORAL T1 LIQUID 2.5-5-100 MG/ML guaifenesin dm oral tablet 400-20 mg T1 guaifenesin er oral tablet extended release 12 T1 hour 1200 mg, 600 mg guaifenesin oral solution 100 mg/5ml T1

39 Drug Status Notes guaifenesin oral tablet 200 mg, 400 mg T1 guaifenesin powder T1 guaifenesin-dm oral syrup 100-10 mg/5ml T1 G-ZYNCOF ORAL SYRUP 20-400 MG/5ML T1 HERBAL EXPEC ORAL LIQUID 150 T1 MG/15ML HISTEX-DM ORAL SYRUP 10-2.5-20 T1 MG/5ML hist-pse oral liquid 0.938-10 mg/ml T1 hydrocod polst-cpm polst er oral suspension T1 QL (240 ML per 30 days) extended release 10-8 mg/5ml hydrocodone-homatropine oral syrup 5-1.5 T1 QL (240 ML per 30 days) mg/5ml hydrocodone-homatropine oral tablet 5-1.5 mg T1 ibu-profen cold/sinus oral tablet 30-200 mg T1 intense cough reliever oral liquid 20-300 mg/5ml, T1 30-200 mg/5ml lexuss 210 oral liquid 2-10 mg/5ml T1 QL (240 ML per 30 days) liquituss gg oral liquid 200 mg/5ml T1 LITTLE REMEDIES FOR COLDS ORAL T1 LIQUID 2.5-1.25-80 MG/ML LODRANE D ORAL CAPSULE 4-60 MG T1 LOHIST-D ORAL LIQUID 2-30 MG/5ML T1 loratadine-d 12hr oral tablet extended release 12 T1 hour 5-120 mg loratadine-d 24hr oral tablet extended release 24 T1 hour 10-240 mg LORTUSS DM ORAL LIQUID 30-6.25-15 T1 MG/5ML LORTUSS LQ ORAL LIQUID 6.25-30 T1 MG/5ML MAR-COF BP ORAL LIQUID 30-2-7.5 T1 QL (240 ML per 30 days) MG/5ML maxi-tuss pe oral liquid 2-5 mg/5ml T1 m-end dmx oral liquid 20-0.667-10 mg/5ml T1 M-END PE ORAL LIQUID 3.33-1.33-6.33 T1 QL (240 ML per 30 days) MG/5ML MUCINEX CHILD MS DAY-NIGHT CLD T1 ORAL MUCINEX COUGH FOR KIDS ORAL T1 PACKET 5-100 MG

40 Drug Status Notes MUCINEX FAST-MAX CONGEST COUGH T1 ORAL TABLET 5-10-200 MG MUCINEX FOR KIDS ORAL PACKET 100 T1 MG MUCINEX SINUS-MAX DAY/NIGHT ORAL T1 mucus d oral tablet extended release 12 hour 120- T1 1200 mg mucus relief cold flu throat oral liquid 5-10-200- T1 325 mg/10ml mucus relief cold/sinus max st oral liquid 10-650- T1 400 mg/20ml mucus relief d oral tablet 40-400 mg T1 mucus relief severe congst/cgh oral liquid 10-20- T1 400 mg/20ml mucus-dm max oral tablet extended release 12 T1 hour 60-1200 mg mucus-dm oral tablet extended release 12 hour T1 30-600 mg nasal mist inhalation aerosol solution 0.9 % T1 NASOPEN ORAL LIQUID 9.375-30 MG/5ML T1 NASOPEN PE ORAL LIQUID 50-10 T1 MG/15ML NEOTUSS PLUS ORAL LIQUID 7.5-4-30 T1 MG/5ML NEOTUSS-D ORAL LIQUID 7.5-30-200 T1 MG/5ML nighttime cough oral liquid 6.25-15 mg/15ml T1 nighttime pain plus sleep oral liquid 25-500 T1 mg/15ml nite-time cold/flu relief oral liquid 5-6.25-15-500 T1 mg/15ml NIVANEX DMX ORAL TABLET 10-15-380 T1 MG nohist-lq oral liquid 4-10 mg/5ml T1 non-pseudo cold relief oral tablet 5-15-200-325 T1 mg NOREL AD ORAL TABLET 4-10-325 MG T1 nortuss-ex oral liquid 20-200 mg/5ml T1 PANATUSS PED DROPS ORAL LIQUID 15- T1 0.5-6.25 MG/ML PANATUSS PED ORAL LIQUID 60-2-25 T1 MG/5ML 41 Drug Status Notes PECGEN DMX ORAL LIQUID 15-125 T1 MG/5ML PEDIACARE CHILD ALLERGY/COLD T1 ORAL LIQUID 12.5-5 MG/5ML pediatric cough/cold oral liquid 15-1-5 mg/5ml T1 phenylephrine-chlorphen-dm oral liquid 1.75- T1 0.75-2.75 mg/ml phenylephrine-dm-gg oral liquid 10-18-200 T1 mg/15ml phenylhistine dh oral liquid 30-2-10 mg/5ml T1 QL (240 ML per 30 days) poly-hist dm oral liquid 5-25-10 mg/5ml T1 poly-hist pd oral liquid 6.25-6.25 mg/ml T1 poly-tussin ac oral liquid 10-4-10 mg/5ml T1 QL (240 ML per 30 days) POLY-VENT DM ORAL TABLET 60-20-380 T1 MG POLY-VENT IR ORAL TABLET 60-380 MG T1 pres gen pediatric oral liquid 2.5-5-75 mg/5ml T1 pro-chlo oral liquid 5-12.5-12.5 mg/5ml T1 PRO-CLEAR AC ORAL SYRUP 9-8.33 T1 QL (240 ML per 30 days) MG/5ML promethazine vc plain oral syrup 6.25-5 mg/5ml T1 promethazine vc/codeine oral syrup 6.25-5-10 T1 QL (240 ML per 30 days) mg/5ml promethazine-codeine oral syrup 6.25-10 mg/5ml T1 QL (240 ML per 30 days) promethazine-dm oral syrup 6.25-15 mg/5ml T1 PRO-RED AC ORAL SYRUP 5-1-9 MG/5ML T1 QL (240 ML per 30 days) pseudoeph-bromphen-dm oral syrup 30-2-10 T1 mg/5ml pseudoephedrine-guaifenesin er oral tablet T1 extended release 12 hour 60-600 mg pyrilamine-phenylephrine oral suspension 5-16 T1 mg/5ml pyrilamine-phenylephrine oral tablet 25-10 mg T1 qc cold relief oral tablet 12.5-500 mg T1 qc cold relief plus oral tablet effervescent 2-5-250 T1 mg qc flu relief therapy night oral liquid 12.5-5-325 T1 mg/15ml qc medifin cp oral tablet 650-400 mg T1 Q-TAPP ORAL ELIXIR 1-15 MG/5ML T1

42 Drug Status Notes ra allergy multi-symptom night oral tablet 25-5- T1 325 mg ra allergy multi-symptom oral tablet 2-5-325 mg T1 ra childrens cold & allergy oral elixir 1-2.5 T1 mg/5ml ra cold & flu oral tablet 2-325 mg T1 ra cold/cough sinus relief pe oral tablet 5-10-100- T1 325 mg ra flu maximum strength oral tablet 15-500-2 mg T1 ra severe cold/night cold&flu oral T1 ra severe cold/sinus relief pe oral tablet 12.5-5- T1 325 mg ra sinus congst/pain day/night oral 2-5-325 & 5- T1 325 mg ra suphedrine day/night combo oral T1 ra suphedrine pe oral tablet 4-10 mg, 5-325 mg T1 ra tussin nighttime cough dm oral liquid 12.5-30 T1 mg/10ml REFENESEN CHEST CONG/PAIN RLF T1 ORAL TABLET 650-400 MG refenesen plus oral tablet 60-400 mg T1 relcof c oral solution 100-6.3 mg/5ml T1 RESCON DM ORAL SYRUP 30-2-10 T1 MG/5ML RESPAIRE-30 ORAL CAPSULE 30-150 MG T1 ROBITUSSIN CHILD COUGH/COLD CF T1 ORAL LIQUID 2.5-5-50 MG/5ML ROBITUSSIN CHILD COUGH/COLD LA T1 ORAL LIQUID 1-7.5 MG/5ML ROBITUSSIN DAY/NIGHT VALUE PAK T1 ORAL ROBITUSSIN PEAK COLD MULTI-SYM T1 ORAL LIQUID 6.25-2.5-160 MG/5ML ROBITUSSIN PK COLD DAY/NGHT DM T1 ORAL ROBITUSSIN PK COLD DAY/NGHT MS T1 ORAL ru-hist d oral tablet 4-10 mg T1 rymed oral tablet 2-10 mg T1 SAFE TUSSIN PM ORAL LIQUID 3.125-7.5 T1 MG/5ML sb daytime sinus oral capsule 5-325 mg T1

43 Drug Status Notes sb nighttime sinus multi-sympt oral capsule 6.25- T1 5-325 mg sb severe cold congestion oral tablet 30-15-200- T1 325 mg SCOT-TUSSIN DM ORAL LIQUID 2-15 T1 MG/5ML SCOT-TUSSIN SENIOR ORAL LIQUID 15- T1 200 MG/5ML SINADRIN PE COMPLETE SINUS REL T1 ORAL TABLET 2-10-650 MG sinus daytime/nighttime oral T1 sinus maximum strength oral tablet 30-500 mg T1 sm cough/runny nose childrens oral liquid 1-5 T1 mg/5ml sm ibuprofren cold childrens oral suspension 15- T1 100 mg/5ml sm pain reliever sinus pe oral tablet 5-500 mg T1 sm tussin cf oral liquid 30-10-100 mg/5ml T1 sodium chloride inhalation nebulization solution T1 0.9 % sonahist dm oral liquid† 2-1-3 mg/ml T1 stahist ad oral liquid 25-60 mg/5ml T1 stahist ad oral tablet 25-60 mg T1 SUDAFED PE DAY & NIGHT ORAL 25-10 & T1 10 MG SUDOGEST SINUS/ALLERGY ORAL T1 TABLET 4-60 MG super strength sinadrin oral tablet 4-10-650 mg T1 supress a pediatric oral liquid 5-1-10 mg/ml T1 supress dm pediatric oral liquid 5-50 mg/ml T1 SUPRESS-PE PEDIATRIC ORAL LIQUID T1 2.5-50 MG/ML terpin hydrate powder T1 tg 10peh/380gfn oral tablet 10-380 mg T1 tgq 15dm/5peh/2cpm oral syrup 15-5-2 mg/5ml T1 tgq 30pse/150gfn/15dm oral syrup 30-150-15 T1 mg/5ml tgq 30pse/3brm/15dm oral syrup 30-3-15 mg/5ml T1 theracaps cough/cold reliever oral tablet 30-2- T1 15-500 mg THERAFLU MAX-D COLD & FLU ORAL T1 PACKET 60-30-400-1000 MG 44 Drug Status Notes THERAFLU SEVERE COLD & COUGH T1 ORAL PACKET THERAFLU SEVERE COLD DAYTIME T1 ORAL TABLET 15-5-325 MG TREXBROM ORAL LIQUID 10-4-25 T1 MG/5ML triactin chest congestion oral solution 50 mg/5ml T1 TRIAMINIC CHEST/NASAL CONGEST T1 ORAL SYRUP 2.5-50 MG/5ML TRIAMINIC COLD/ALLERGY CHILD T1 ORAL SYRUP 1-2.5 MG/5ML TRIAMINIC COLD/COUGH DAY TIME T1 ORAL SOLUTION 2.5-5 MG/5ML TRIAMINIC COUGH & SORE THROAT T1 ORAL SYRUP 160-5 MG/5ML TRIAMINIC COUGH/SORE THROAT T1 ORAL TABLET CHEWABLE 160-5 MG TRIAMINIC NIGHT TIME COLD/CGH T1 ORAL SYRUP 6.25-2.5 MG/5ML trigofen dm oral liquid 2-1-3 mg/ml T1 TRISPEC DMX ORAL LIQUID 10-187 T1 MG/5ML TRISPEC PSE PEDIATRIC ORAL LIQUID T1 30-10-187 MG/5ML trymine cg oral liquid 225-7.5 mg/5ml T1 TUSICOF ORAL LIQUID 10-20-400 T1 MG/5ML TUSICOF ORAL TABLET 10-20-400 MG T1 TUSNEL C ORAL SYRUP 30-10-100 T1 MG/5ML TUSNEL ORAL CAPSULE 2-15-200 MG T1 TUSNEL ORAL LIQUID 30-15-200 MG/5ML T1 TUSNEL PEDIATRIC ORAL LIQUID 15-5- T1 50 MG/5ML tussafex ex oral liquid 10-30-200 mg/5ml T1 tussafex-a oral liquid 6-2-15 mg/5ml T1 tussin cf cough & cold oral liquid 5-10-100 T1 mg/5ml tussin cf max multi-symptom oral liquid 5-10-200 T1 mg/5ml tussin chest congestion oral syrup 100 mg/5ml T1 tussin cold/congestion oral capsule 30-10-200 mg T1

45 Drug Status Notes tussin cough oral syrup 15 mg/5ml T1 tussin dm max oral liquid 10-200 mg/5ml T1 tussi-pres b oral liquid 10-4-20 mg/5ml T1 TUSSLIN ORAL LIQUID 10-28-388 MG/5ML T1 TUSSLIN PEDIATRIC ORAL LIQUID 2.5- T1 7.5-88 MG/ML TYLENOL CHILDRENS COLD/STUFFY T1 ORAL SUSPENSION 2.5-160 MG/5ML TYLENOL CHILDRENS PLUS CLD/CGH T1 ORAL SUSPENSION 5-2.5-160 MG/5ML VANACOF APE ORAL LIQUID 10-50-25 T1 MG/15ML VANACOF G ORAL LIQUID 25-200 T1 MG/5ML VANACOF GPE ORAL LIQUID 10-25-200 T1 MG/15ML VANACOF-8 ORAL LIQUID 25-50 T1 MG/15ML VANATAB DX ORAL TABLET 30-12.5-200 T1 MG vaporizing steam inhalation liquid 6.2 % T1 VAZOBID-PD ORAL SUSPENSION 6-10 T1 MG/5ML VICKS DAYQUIL MUCUS CONTROL DM T1 ORAL LIQUID 10-200 MG/15ML VICKS DAYQUIL SEVERE COLD/FLU T1 ORAL LIQUID 5-10-200-325 MG/15ML VICKS NATURE FUSION COLD & FLU T1 ORAL LIQUID 30-7.5-650 MG/30ML VICKS NATURE FUSION CONGEST ORAL T1 LIQUID 20-200 MG/30ML VICKS NYQUIL CHILDRENS CLD/CGH T1 ORAL LIQUID 2-15 MG/15ML VICKS NYQUIL COLD & FLU NIGHT T1 ORAL LIQUID 30-650-4 MG/30ML virdec dm oral liquid 3.5-1-3 mg/ml T1 virdec oral liquid 1-3.5 mg/ml T1 WAL-DRYL PE ALLERGY & SINUS ORAL T1 TABLET 25-10 MG WAL-FLU COLD & SORE THROAT ORAL T1 PACKET 20-10-325 MG WAL-FLU SEVERE COLD DAYTIME T1 ORAL PACKET 10-650 MG 46 Drug Status Notes ZODRYL DEC 25 ORAL SUSPENSION 5-1- T1 20 MG/ML ZODRYL DEC 30 ORAL SUSPENSION T1 4.286-1-20 MG/ML ZODRYL DEC 35 ORAL SUSPENSION 3.75- T1 1-20 MG/ML ZODRYL DEC 40 ORAL SUSPENSION T1 3.333-1-20 MG/ML Z-TUSS AC ORAL LIQUID 2-9 MG/5ML T1 QL (240 ML per 30 days) ZYNCOF ORAL SYRUP 20-400 MG/5ML T1 *Dermatologicals* acne medication 10 external lotion 10 % T1 acne medication 5 external lotion 5 % T1 adapalene external gel 0.1 % T1 QL (45 GM per 30 days) ADULT ACNOMEL EXTERNAL CREAM 2- T1 8 % alclometasone dipropionate external cream 0.05 T1 % alclometasone dipropionate external ointment T1 0.05 % alevazol external ointment 1 % T1 ammonium lactate external cream 12 % T1 QL (385 GM per 30 days) ammonium lactate external lotion 12 % T1 QL (385 GM per 30 days) ANECREAM EXTERNAL CREAM 4 % T1 ASPERCREME LIDOCAINE PATCH 4 % T1 QL (30 EA per 30 days) EXTERNAL 4 % ASPERCREME W/LIDOCAINE EXTERNAL T1 CREAM 4 % bacitracin external ointment 500 unit/gm T1 bacitracin zinc external ointment 500 unit/gm T1 bacitracin-neomycin-polymyxin external ointment T1 400-5-5000 BASIS OVERNIGHT EXTERNAL CREAM T1 benzoyl peroxide cleanser external lotion 6 % T1 benzoyl peroxide external gel 10 %, 2.5 %, 5 % T1 benzoyl peroxide wash external liquid 10 %, 5 % T1 benzoyl peroxide-erythromycin external gel 5-3 % T1 QL (46.6 GM per 30 days) betamethasone dipropionate aug external cream T1 QL (100 GM per 30 days) 0.05 % betamethasone dipropionate external cream 0.05 T1 QL (90 GM per 30 days) %

47 Drug Status Notes betamethasone dipropionate external lotion 0.05 T1 % betamethasone dipropionate external ointment T1 QL (90 GM per 30 days) 0.05 % betamethasone valerate external cream 0.1 % T1 QL (90 GM per 30 days) betamethasone valerate external lotion 0.1 % T1 QL (120 ML per 30 days) betamethasone valerate external ointment 0.1 % T1 QL (90 GM per 30 days) bp cleansing external lotion 4 % T1 bp cleansing wash external emulsion 10-4 % T1 BRASIVOL EXTERNAL PASTE T1 CALAGESIC EXTERNAL LOTION 1-8 % T1 capsaicin external cream 0.025 %, 0.1 % T1 CAPZASIN EXTERNAL LIQUID 0.15 % T1 CASTIVA WARMING EXTERNAL LOTION T1 0.035 % ciclopirox external solution 8 % T1 QL (6.6 ML per 30 days) CLEAN & CLEAR ACNE CONTROL T1 EXTERNAL KIT 0.5 & 2 & 10 % clindamycin phosphate external solution 1 % T1 clindamycin phosphate external swab 1 % T1 QL (60 EA per 30 days) clobetasol propionate external cream 0.05 % T1 clobetasol propionate external solution 0.05 % T1 QL (100 ML per 30 days) clotrimazole external cream 1 % T1 clotrimazole external solution 1 % T1 clotrimazole-betamethasone external cream 1- T1 QL (90 GM per 30 days) 0.05 % clotrimazole-betamethasone external lotion 1- T1 QL (60 ML per 30 days) 0.05 % CORTISPORIN EXTERNAL OINTMENT 1 T1 % CORTIZONE-10/ALOE EXTERNAL T1 QL (36 ML per 30 days) LIQUID 1 % cvs cortisone cooling relief external gel 1 % T1 QL (60 GM per 30 days) cvs hydrocortisone acetate external cream 0.5 % T1 QL (120 GM per 30 days) cvs targeted acne spot external cream 2.5 % T1 DENOREX DUAL FORCE EXTERNAL T1 SHAMPOO 1 & 3 % desonide external ointment 0.05 % T1 QL (120 GM per 30 days) diclofenac sodium transdermal gel 1 % T1 QL (200 GM per 30 days) DIFFERIN EXTERNAL GEL 0.1 % T1 QL (45 GM per 30 days)

48 Drug Status Notes diflorasone diacetate external ointment 0.05 % T1 docosanol external cream 10 % T1 DUPIXENT SUBCUTANEOUS SOLUTION PEN-INJECTOR 200 MG/1.14ML, 300 T1 PA MG/2ML DUPIXENT SUBCUTANEOUS SOLUTION T1 PA PREFILLED SYRINGE 300 MG/2ML econazole nitrate external cream 1 % T1 effaclar duo external solution 5.5 % T1 erythromycin external gel 2 % T1 erythromycin external solution 2 % T1 ethyl chloride external aerosol T1 EUCERIN EXTERNAL CREAM T1 EXODERM EXTERNAL BAR 10-3 % T1 first aid antibiotic external ointment 4 % T1 fluocinolone acetonide body external oil 0.01 % T1 QL (120 ML per 30 days) fluocinolone acetonide external cream 0.01 %, T1 QL (120 GM per 30 days) 0.025 % fluocinolone acetonide external ointment 0.025 % T1 QL (120 GM per 30 days) fluocinolone acetonide scalp external oil 0.01 % T1 QL (120 ML per 30 days) fluocinonide external cream 0.05 % T1 QL (120 GM per 30 days) fluocinonide external gel 0.05 % T1 QL (120 GM per 30 days) fluocinonide external ointment 0.05 % T1 QL (120 GM per 30 days) fluocinonide external solution 0.05 % T1 QL (120 ML per 30 days) fluocinonide-e external cream 0.05 % T1 QL (120 GM per 30 days) fluorouracil external cream 5 % T1 fluorouracil external solution 2 %, 5 % T1 fluticasone propionate external cream 0.05 % T1 QL (120 GM per 30 days) fluticasone propionate external ointment 0.005 % T1 FUNGOID TINCTURE EXTERNAL T1 SOLUTION 2 % gentamicin sulfate external cream 0.1 % T1 gentamicin sulfate external ointment 0.1 % T1 glycerin external liquid T1 GRANDPAS THYLOX SOAP EXTERNAL T1 BAR 3 % granulderm external aerosol, solution 650-72.5- T1 QL (60 GM per 30 days) 0.1 mg/0.82ml halobetasol propionate external cream 0.05 % T1 halobetasol propionate external ointment 0.05 % T1 QL (100 GM per 30 days)

49 Drug Status Notes HC DERMAPAX EXTERNAL LIQUID 0.5- T1 0.5 % hydrocortisone external cream 0.5 % T1 QL (60 GM per 30 days) hydrocortisone external cream 2.5 % T1 QL (90 GM per 30 days) hydrocortisone external lotion 1 % T1 QL (240 GM per 30 days) hydrocortisone external lotion 2.5 % T1 QL (120 ML per 30 days) hydrocortisone external ointment 0.5 %, 1 % T1 QL (60 GM per 30 days) hydrocortisone external ointment 2.5 % T1 QL (90 GM per 30 days) hydrocortisone max st external cream 1 % T1 QL (120 GM per 30 days) hydrocortisone valerate external cream 0.2 % T1 hydrocortisone valerate external ointment 0.2 % T1 QL (120 GM per 30 days) hydrocortisone-aloe external cream 0.5 %, 1 % T1 QL (90 GM per 30 days) isopropyl alcohol wipes external 70 % T1 ketoconazole external cream 2 % T1 ketoconazole external shampoo 2 % T1 LAC-HYDRIN FIVE EXTERNAL LOTION 5 T1 % lactic acid e external cream 10-3500 %-unt/30gm T1 lactic acid external lotion 10 % T1 lc-4 lidocaine external cream 4 % T1 lice killing maximum strength external shampoo T1 0.33-4 % lice solution combination kit 0.33-4-0.5 % T1 lice treatment external liquid 0.33-4 %, 1 % T1 LICEMD EXTERNAL GEL 0.33-4 % T1 LICIDE TREATMENT COMBINATION KIT T1 lidocaine external cream 4 % T1 QL (90 GM per 30 days) lidocaine hcl external gel 2 % T1 lidocaine hcl external solution 4 % T1 lidocaine-prilocaine external cream 2.5-2.5 % T1 QL (30 GM per 30 days) lindane external lotion 1 % T1 lindane external shampoo 1 % T1 LIQUIMAT EXTERNAL LOTION 5 % T1 LMX 4 EXTERNAL CREAM 4 % T1 LOTRIMIN AF EXTERNAL AEROSOL 2 % T1 malathion external lotion 0.5 % T1 medi-first hydrocortisone external cream 1 % T1 QL (60 EA per 30 days) metronidazole external cream 0.75 % T1

50 Drug Status Notes metronidazole external gel 0.75 % T1 metronidazole external lotion 0.75 % T1 miconazole nitrate external aerosol powder 2 % T1 miconazole nitrate external cream 2 % T1 miconazorb af external powder 2 % T1 mometasone furoate external cream 0.1 % T1 QL (60 GM per 30 days) mometasone furoate external ointment 0.1 % T1 QL (60 GM per 30 days) mometasone furoate external solution 0.1 % T1 QL (60 ML per 30 days) mupirocin external ointment 2 % T1 NEOSPORIN ESSENTIALS TRIAL PK T1 EXTERNAL KIT 1 & 1 % NEUTROGENA CLEAR PORE EXTERNAL T1 LIQUID 3.5 % NOBLE MYSTIQUE EMU-LAC EXTERNAL T1 CREAM 10 % NUOX EXTERNAL GEL 6-3 % T1 nystatin external cream 100000 unit/gm T1 nystatin external ointment 100000 unit/gm T1 nystatin external powder 100000 unit/gm T1 nystatin-triamcinolone external cream 100000- T1 0.1 unit/gm-% nystatin-triamcinolone external ointment 100000- T1 0.1 unit/gm-% OC8 EXTERNAL GEL 7 % T1 PANOXYL-8 CREAMY WASH EXTERNAL T1 LIQUID 8 % permethrin external cream 5 % T1 QL (120 GM per 30 days) permethrin external lotion 1 % T1 podofilox external solution 0.5 % T1 PRAMOSONE EXTERNAL CREAM 1-1 % T1 QL (30 GM per 30 days) prednicarbate external ointment 0.1 % T1 QL (60 GM per 30 days) PRO:12 MOUSSE AL12 EXTERNAL FOAM T1 12 % PRONTO AEROSOL 0.4 % T1 pyrethins-piperonyl butoxide external liquid 0.2-2 T1 % ra acne maximum external pad 2 % T1 ra acne treatment external cream 10 % T1 ra first aid anti-itch spray external solution 1 % T1 QL (90 GM per 30 days) ra lice bedding aerosol 0.5 % T1

51 Drug Status Notes ra lice egg remover external gel T1 ra lice solution combination kit 0.5-0.33-4 % T1 ra wart remover external pad 40 % T1 resorcinol-sulfur external lotion 2-5 % T1 RID ESSENTIAL LICE ELIMINATION T1 EXTERNAL KIT 0.33-4 % SANTYL EXTERNAL OINTMENT 250 T1 QL (60 GM per 30 days) UNIT/GM SCHOOLTIME SHAMPOO EXTERNAL T1 SHAMPOO sebex external shampoo 2-2 % T1 selenium sulfide external lotion 2.5 % T1 silver sulfadiazine external cream 1 % T1 STEP 2 EXTERNAL SOLUTION 8 % T1 sulfacetamide sodium (acne) external lotion 10 % T1 sulfacetamide sodium-sulfur external emulsion T1 10-5 % sulfacetamide sodium-sulfur external liquid 9-4.5 T1 % sulfurated lime external solution T1 tbc external aerosol solution 650-72.5-0.1 T1 QL (60 GM per 30 days) mg/0.82ml terbinafine hcl external cream 1 % T1 triamcinolone acetonide external cream 0.025 %, T1 QL (160 GM per 30 days) 0.1 % triamcinolone acetonide external cream 0.5 % T1 QL (60 GM per 30 days) triamcinolone acetonide external lotion 0.025 %, T1 QL (120 ML per 30 days) 0.1 % triamcinolone acetonide external ointment 0.025 T1 QL (160 GM per 30 days) %, 0.1 % triamcinolone acetonide external ointment 0.5 % T1 QL (60 GM per 30 days) triple paste af external ointment 2 % T1 trixaicin hp external cream 0.075 % T1 urea external cream 40 % T1 VASOLEX EXTERNAL OINTMENT T1 QL (60 GM per 30 days) ZEASORB-AF EXTERNAL LOTION 2 % T1 *Diagnostic Products* GLUCOCARD EXPRESSION TEST IN T1 VITRO STRIP GLUCOCARD VITAL TEST IN VITRO T1 STRIP 52 Drug Status Notes KETOSTIX IN VITRO STRIP T1 ONETOUCH VERIO STRIP IN VITRO T1 PRECISION XTRA KETONE IN VITRO T1 STRIP *Dietary Products/Dietary Management Products* complete protein/vitamin shake oral powder T1 *Digestive Aids* CREON ORAL CAPSULE DELAYED RELEASE PARTICLES 12000-38000 UNIT, T1 24000-76000 UNIT, 3000-9500 UNIT, 36000- 114000 UNIT, 6000-19000 UNIT PANCREAZE ORAL CAPSULE DELAYED RELEASE PARTICLES 10500-35500 UNIT, T1 16800-56800 UNIT, 21000-54700 UNIT, 4200- 14200 UNIT pancrelipase (lip-prot-amyl) oral capsule delayed T1 release particles 5000 unit PERTZYE ORAL CAPSULE DELAYED RELEASE PARTICLES 16000-57500 UNIT, T1 8000-28750 UNIT ULTRESA ORAL CAPSULE DELAYED RELEASE PARTICLES 13800 UNIT, 20700 T1 UNIT, 23000 UNIT VIOKACE ORAL TABLET 10440-39150 T1 UNIT, 20880-78300 UNIT ZENPEP ORAL CAPSULE DELAYED RELEASE PARTICLES 10000 UNIT, 15000- 51000 UNIT, 20000-68000 UNIT, 25000 UNIT, T1 3000-10000 UNIT, 40000-136000 UNIT, 5000 UNIT *Diuretics* acetazolamide er oral capsule extended release T1 QL (60 EA per 30 days) 12 hour 500 mg acetazolamide oral tablet 125 mg, 250 mg T1 amiloride hcl oral tablet 5 mg T1 amiloride-hydrochlorothiazide oral tablet 5-50 T1 mg bumetanide oral tablet 0.5 mg, 1 mg, 2 mg T1 CAROSPIR ORAL SUSPENSION 25 T1 AL (Max 12 Years) MG/5ML chlorothiazide oral tablet 250 mg, 500 mg T1 chlorthalidone oral tablet 100 mg, 25 mg, 50 mg T1 53 Drug Status Notes QL (600 ML per 30 days); AL DIURIL ORAL SUSPENSION 250 MG/5ML T1 (Max 12 Years) furosemide injection solution 10 mg/ml T1 furosemide oral solution 10 mg/ml T1 furosemide oral tablet 20 mg, 40 mg, 80 mg T1 hydrochlorothiazide oral capsule 12.5 mg T1 hydrochlorothiazide oral tablet 12.5 mg, 25 mg, T1 50 mg indapamide oral tablet 1.25 mg, 2.5 mg T1 methazolamide oral tablet 25 mg T1 methyclothiazide oral tablet 5 mg T1 metolazone oral tablet 10 mg, 2.5 mg, 5 mg T1 spironolactone oral tablet 100 mg, 25 mg, 50 mg T1 spironolactone-hctz oral tablet 25-25 mg T1 torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg T1 triamterene-hctz oral capsule 37.5-25 mg T1 triamterene-hctz oral tablet 37.5-25 mg, 75-50 mg T1 *Endocrine And Metabolic Agents - Misc.* alendronate sodium oral tablet 10 mg, 35 mg, 40 T1 mg, 5 mg, 70 mg calcitonin (salmon) nasal solution 200 unit/act T1 calcitriol oral capsule 0.25 mcg, 0.5 mcg T1 desmopressin ace spray refrig nasal solution 0.01 T1 % desmopressin acetate oral tablet 0.1 mg, 0.2 mg T1 desmopressin acetate spray nasal solution 0.01 % T1 GENOTROPIN MINIQUICK SUBCUTANEOUS SOLUTION RECONSTITUTED 0.2 MG, 0.4 MG, 0.6 MG, T1 PA 0.8 MG, 1 MG, 1.2 MG, 1.4 MG, 1.6 MG, 1.8 MG, 2 MG GENOTROPIN SUBCUTANEOUS SOLUTION RECONSTITUTED 12 MG, 5 T1 PA MG ibandronate sodium oral tablet 150 mg T1 QL (1 EA per 28 days) LUPRON DEPOT-PED (1-MONTH) INTRAMUSCULAR KIT 11.25 MG, 15 MG, T1 PA 7.5 MG NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 10 MG/1.5ML T1 PA SUBCUTANEOUS 10 MG/1.5ML 54 Drug Status Notes NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 15 MG/1.5ML T1 PA SUBCUTANEOUS 15 MG/1.5ML NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 30 MG/3ML T1 PA SUBCUTANEOUS 30 MG/3ML NORDITROPIN FLEXPRO SOLUTION PEN-INJECTOR 5 MG/1.5ML T1 PA SUBCUTANEOUS 5 MG/1.5ML NORDITROPIN FLEXPRO SUBCUTANEOUS SOLUTION 10 T1 PA MG/1.5ML, 15 MG/1.5ML, 30 MG/3ML, 5 MG/1.5ML raloxifene hcl oral tablet 60 mg T1 risedronate sodium oral tablet 150 mg, 30 mg, 35 T1 mg, 5 mg SENSIPAR ORAL TABLET 30 MG, 60 MG, T1 PA 90 MG *Estrogens* estradiol oral tablet 0.5 mg, 1 mg, 2 mg T1 GR-F estradiol transdermal patch twice weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.075 T1 GR-F; QL (8 EA per 28 days) mg/24hr, 0.1 mg/24hr estradiol transdermal patch weekly 0.025 mg/24hr, 0.0375 mg/24hr, 0.05 mg/24hr, 0.06 T1 GR-F; QL (4 EA per 28 days) mg/24hr, 0.075 mg/24hr, 0.1 mg/24hr estradiol-norethindrone acet oral tablet 0.5-0.1 T1 GR-F; QL (28 EA per 28 days) mg, 1-0.5 mg estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg T1 GR-F; QL (21 EA per 28 days) JINTELI ORAL TABLET 1-5 MG-MCG T1 GR-F; QL (21 EA per 28 days) MENEST ORAL TABLET 0.3 MG, 0.625 MG, T1 GR-F 1.25 MG, 2.5 MG norethindrone-eth estradiol oral tablet 0.5-2.5 T1 GR-F; QL (28 EA per 28 days) mg-mcg PREMARIN ORAL TABLET 0.3 MG, 0.45 T1 GR-F; QL (30 EA per 30 days) MG, 0.625 MG, 0.9 MG, 1.25 MG PREMPHASE ORAL TABLET 0.625-5 MG T1 GR-F; QL (30 EA per 30 days) PREMPRO ORAL TABLET 0.3-1.5 MG, 0.45- T1 GR-F; QL (30 EA per 30 days) 1.5 MG, 0.625-2.5 MG, 0.625-5 MG *Fluoroquinolones* CIPRO ORAL SUSPENSION T1 RECONSTITUTED 500 MG/5ML (10%)

55 Drug Status Notes ciprofloxacin hcl oral tablet 250 mg, 500 mg, 750 T1 mg levofloxacin oral tablet 250 mg, 500 mg, 750 mg T1 moxifloxacin hcl oral tablet 400 mg T1 ofloxacin oral tablet 400 mg T1 *Gastrointestinal Agents - Misc.* APRISO ORAL CAPSULE EXTENDED T1 QL (120 EA per 30 days) RELEASE 24 HOUR 0.375 GM balsalazide disodium oral capsule 750 mg T1 BICARSIM FORTE ORAL TABLET 125 MG T1 BICARSIM ORAL TABLET 80 MG T1 calcium acetate (phos binder) oral capsule 667 T1 mg calcium acetate (phos binder) oral tablet 667 mg T1 cvs gas relief drops ex st oral liquid 40 mg/0.6ml T1 GAS-X EXTRA STRENGTH ORAL STRIP T1 62.5 MG lactulose encephalopathy oral solution 10 T1 gm/15ml mesalamine oral capsule delayed release 400 mg T1 QL (180 EA per 30 days) mesalamine oral tablet delayed release 1.2 gm T1 QL (60 EA per 30 days) mesalamine rectal enema 4 gm T1 QL (240 ML per 30 days) metoclopramide hcl oral solution 10 mg/10ml, 5 T1 mg/5ml metoclopramide hcl oral tablet 10 mg, 5 mg T1 RENAGEL ORAL TABLET 400 MG T1 PA sevelamer hcl oral tablet 800 mg T1 PA SFROWASA RECTAL ENEMA 4 GM/60ML T1 QL (240 ML per 30 days) simethicone oral capsule 125 mg, 180 mg T1 simethicone oral suspension 20 mg/0.3ml T1 simethicone oral tablet chewable 125 mg, 80 mg T1 sulfasalazine oral tablet 500 mg T1 sulfasalazine oral tablet delayed release 500 mg T1 ursodiol oral capsule 300 mg T1 ursodiol oral tablet 250 mg, 500 mg T1 *Genitourinary Agents - Miscellaneous* alfuzosin hcl er oral tablet extended release 24 T1 hour 10 mg citric acid-sodium citrate oral solution 334-500 T1 mg/5ml

56 Drug Status Notes cytra k crystals oral packet 3300-1002 mg T1 cytra-2 oral solution 500-334 mg/5ml T1 CYTRA-3 ORAL SYRUP 550-500-334 T1 MG/5ML cytra-k oral solution 1100-334 mg/5ml T1 finasteride oral tablet 5 mg T1 K-PHOS NO 2 ORAL TABLET 305-700 MG T1 ORACIT ORAL SOLUTION 490-640 T1 MG/5ML phenazopyridine hcl oral tablet 100 mg, 200 mg, T1 95 mg potassium citrate-citric acid oral packet 3300- T1 1002 mg potassium citrate-citric acid oral solution 1100- T1 334 mg/5ml sodium chloride irrigation solution 0.9 % T1 tamsulosin hcl oral capsule 0.4 mg T1 *Gout Agents* allopurinol oral tablet 100 mg, 300 mg T1 colchicine oral capsule 0.6 mg T1 QL (60 EA per 30 days) colchicine oral tablet 0.6 mg T1 QL (60 EA per 30 days) colchicine-probenecid oral tablet 0.5-500 mg T1 probenecid oral tablet 500 mg T1 *Hematological Agents - Misc.* anagrelide hcl oral capsule 0.5 mg, 1 mg T1 BRILINTA ORAL TABLET 60 MG, 90 MG T1 QL (60 EA per 30 days) cilostazol oral tablet 100 mg, 50 mg T1 clopidogrel bisulfate oral tablet 300 mg T1 clopidogrel bisulfate oral tablet 75 mg T1 QL (30 EA per 30 days) dipyridamole oral tablet 25 mg, 50 mg, 75 mg T1 pentoxifylline er oral tablet extended release 400 T1 QL (90 EA per 30 days) mg prasugrel hcl oral tablet 10 mg, 5 mg T1 PA ticlopidine hcl oral tablet 250 mg T1 *Hematopoietic Agents* cyanocobalamin injection solution 1000 mcg/ml T1 ELITE IRON ORAL TABLET 15 MG T1 EPOGEN INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, T1 PA 3000 UNIT/ML, 4000 UNIT/ML 57 Drug Status Notes EZFE 200 ORAL CAPSULE 434.8 (200 FE) T1 MG FEMIRON ORAL TABLET 63 (20 FE) MG T1 ferretts chewable iron oral tablet chewable 18 mg T1 ferretts ips oral solution 40 mg/15ml T1 ferretts oral tablet 325 (106 fe) mg T1 FERRIMIN 150 ORAL TABLET 150 MG T1 ferrous aspartate oral tablet 112 (18 fe) mg T1 ferrous fumarate oral tablet 29 mg, 324 (106 fe) T1 mg ferrous gluconate oral tablet 225 (27 fe) mg, 240 (27 fe) mg, 324 (37.5 fe) mg, 324 (38 fe) mg, 325 T1 (36 fe) mg ferrous sulfate er oral tablet extended release 140 T1 (45 fe) mg, 50 mg ferrous sulfate granules T1 ferrous sulfate oral elixir 220 (44 fe) mg/5ml T1 AL (Max 12 Years) ferrous sulfate oral solution 75 (15 fe) mg/ml T1 AL (Max 12 Years) ferrous sulfate oral syrup 300 (60 fe) mg/5ml T1 AL (Max 12 Years) ferrous sulfate oral tablet 27 mg, 325 (65 fe) mg T1 ferrous sulfate oral tablet delayed release 324 (65 T1 fe) mg, 325 (65 fe) mg folic acid oral tablet 1 mg T1 GR-F; QL (30 EA per 30 days); folic acid oral tablet 400 mcg, 800 mcg T1 AL (Min 14 Years and Max 50 Years) FOLITAB 500 ORAL TABLET EXTENDED T1 RELEASE 105-500-0.8 MG high potency iron oral capsule 86 (27 fe) mg T1 high potency iron oral tablet 134 mg T1 hm iron oral tablet 200 (65 fe) mg T1 IFEREX 150 ORAL CAPSULE 150 MG T1 iron (ferrous gluconate) oral tablet 256 (28 fe) T1 mg iron chews pediatric oral tablet chewable 15 mg T1 iron complex oral capsule T1 iron oral tablet 90 (18 fe) mg T1 iron oral tablet extended release 18 mg T1 IRON UP ORAL LIQUID 15 MG/0.5ML T1 MYKIDZ IRON 10 ORAL SUSPENSION 15 T1 MG/1.5ML

58 Drug Status Notes NOVAFERRUM 50 ORAL CAPSULE 50 MG T1 NOVAFERRUM PEDIATRIC DROPS ORAL T1 LIQUID 15 MG/ML PERFECT IRON ORAL TABLET 25 MG T1 poly-iron 150 forte oral capsule 150-25-1 mg- T1 mcg-mg PROCRIT INJECTION SOLUTION 10000 UNIT/ML, 2000 UNIT/ML, 20000 UNIT/ML, T1 PA 3000 UNIT/ML, 4000 UNIT/ML, 40000 UNIT/ML PROFE ORAL CAPSULE 391.3 (180 FE) MG T1 PROFERRIN ES ORAL TABLET 12 MG T1 RETACRIT INJECTION SOLUTION 20000 T1 PA UNIT/ML slow iron oral tablet extended release 160 (50 fe) T1 mg slow release iron oral tablet extended release 45 T1 mg, 47.5 mg sm slow release iron oral tablet extended release T1 142 (45 fe) mg, 143 (45 fe) mg SPATONE PUR-ABSORB IRON ORAL T1 AL (Max 12 Years) LIQUID 5 MG/20ML tl icon oral capsule T1 vitamin b-12 oral tablet 1000 mcg T1 wee care oral suspension 15 mg/1.25ml T1 ZARXIO INJECTION SOLUTION PREFILLED SYRINGE 300 MCG/0.5ML, 480 T1 PA MCG/0.8ML *Hemostatics* tranexamic acid oral tablet 650 mg T1 *Hypnotics/Sedatives/Sleep Disorder Agents* ACETADRYL ORAL TABLET 25-500 MG T1 diphenhydramine hcl (sleep) oral tablet 50 mg T1 PA diphenhydramine-apap (sleep) oral tablet 25-500 T1 mg estazolam oral tablet 1 mg, 2 mg T1 QL (30 EA per 30 days); AL (Max eszopiclone oral tablet 1 mg, 2 mg, 3 mg T1 64 Years) flurazepam hcl oral capsule 15 mg, 30 mg T1 ibuprofen pm oral tablet 200-38 mg T1

59 Drug Status Notes phenobarbital oral solution 20 mg/5ml T1 phenobarbital oral tablet 100 mg, 15 mg, 16.2 T1 mg, 30 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg ra sleep aid (diphenhydramine) oral tablet 25 mg T1 PA ra sleep aid oral capsule 50 mg T1 PA ra sleep aid oral liquid 50 mg/30ml T1 PA ra sleep-aid nighttime oral capsule 25 mg T1 PA QL (30 EA per 30 days); AL (Max temazepam oral capsule 15 mg, 30 mg T1 64 Years) triazolam oral tablet 0.125 mg, 0.25 mg T1 AL (Max 64 Years) wal-som oral tablet dispersible 25 mg T1 PA zaleplon oral capsule 10 mg, 5 mg T1 zolpidem tartrate er oral tablet extended release QL (30 EA per 30 days); AL (Min T1 12.5 mg, 6.25 mg 18 Years) QL (30 EA per 30 days); AL (Max zolpidem tartrate oral tablet 10 mg, 5 mg T1 64 Years) *Laxatives* AGORAL MAXIMUM STRENGTH ORAL T1 LIQUID 25 MG/15ML bisacodyl ec oral tablet delayed release 5 mg T1 bisacodyl rectal suppository 10 mg T1 CORRECTOL HERBAL TEA ORAL 30 MG T1 cvs mini enema kids rectal enema 100 mg/5ml T1 cvs natural fiber supplement oral packet 58.6 % T1 diocto oral syrup 60 mg/15ml T1 docusate calcium oral capsule 240 mg T1 docusate sodium oral capsule 100 mg, 250 mg T1 docusate sodium oral liquid 50 mg/5ml T1 docusate sodium oral tablet 100 mg T1 DOCUSOL MINI RECTAL ENEMA 283 T1 MG/5ML DOCUSOL PLUS MINI-ENEMA RECTAL T1 ENEMA 20-283 MG EQUALACTIN ORAL TABLET T1 CHEWABLE 625 MG EVAC-U-GEN ORAL TABLET CHEWABLE T1 10 MG fiber laxative oral capsule 0.52 gm T1 fiber laxative oral tablet 625 mg T1 fiber therapy oral powder 58.6 % T1

60 Drug Status Notes FLEET BISACODYL RECTAL ENEMA 10 T1 MG/30ML GAVILYTE-C ORAL SOLUTION QL (4000 ML per 365 days); AL T1 RECONSTITUTED 240 GM (Min 50 Years and Max 75 Years) GAVILYTE-G ORAL SOLUTION QL (4000 ML per 365 days); AL T1 RECONSTITUTED 236 GM (Min 50 Years and Max 75 Years) geri-mucil oral powder 68 % T1 glycerin (adult) rectal suppository 2.1 gm T1 glycerin (infants & children) rectal suppository 1 T1 gm, 1.2 gm glycerin adult rectal suppository 2 gm T1 GOLYTELY ORAL SOLUTION T1 QL (1 EA per 365 days) RECONSTITUTED 227.1 GM HYDROCIL ORAL PACKET 95 % T1 konsyl daily fiber oral packet 100 % T1 KONSYL ORAL PACKET 28.3 %, 60.3 % T1 KONSYL ORAL POWDER 60.3 %, 71.67 % T1 KONSYL-D ORAL POWDER 52.3 % T1 lactulose oral solution 10 gm/15ml T1 laxative pills oral tablet 15 mg T1 magnesium citrate oral solution 1.745 gm/30ml T1 METAMUCIL MULTIHEALTH FIBER T1 ORAL POWDER 55.46 % METAMUCIL ORAL WAFER T1 METAMUCIL SMOOTH TEXTURE ORAL T1 PACKET 28 % natural fiber laxative oral powder 28.3 %, 48.57 T1 % natural psyllium seed oral powder 100 % T1 natural senna laxative oral tablet 64.8-324 mg T1 PEDIA-LAX ORAL LIQUID 50 MG/15ML T1 PEDIA-LAX RECTAL SUPPOSITORY 2.8 T1 GM peg 3350 oral packet 17 gm T1 peg 3350/electrolytes oral solution reconstituted QL (4000 ML per 365 days); AL T1 240 gm (Min 50 Years and Max 75 Years) polyethylene glycol 3350 oral powder 17 T1 gm/scoop qc natural vegetable oral powder 95 % T1 ra col-rite oral capsule 50 mg T1 ra glycerin child rectal suppository 80.7 % T1

61 Drug Status Notes ra laxative extra strength oral tablet 17.2 mg T1 ra laxative oral tablet chewable 15 mg T1 sb natural fiber laxative oral powder 49 % T1 senna laxative oral tablet 25 mg T1 senna leaves oral leaves T1 senna oral capsule 8.6 mg T1 senna oral syrup 176 mg/5ml, 8.8 mg/5ml T1 senna oral tablet 8.6 mg T1 senna-docusate sodium oral tablet 8.6-50 mg T1 SOLUBLE FIBER THERAPY ORAL T1 POWDER TRILYTE ORAL SOLUTION QL (4000 ML per 365 days); AL T1 RECONSTITUTED 420 GM (Min 50 Years and Max 75 Years) *Local Anesthetics-Parenteral* lidocaine hcl (pf) injection solution 4 % T1 *Macrolides* azithromycin oral packet 1 gm T1 QL (2 EA per 30 days) azithromycin oral suspension reconstituted 100 T1 mg/5ml, 200 mg/5ml azithromycin oral tablet 250 mg T1 QL (12 EA per 30 days) azithromycin oral tablet 500 mg T1 QL (5 EA per 30 days) azithromycin oral tablet 600 mg T1 clarithromycin oral suspension reconstituted 125 T1 mg/5ml, 250 mg/5ml clarithromycin oral tablet 250 mg, 500 mg T1 *Medical Devices And Supplies* 1st tier unifine pentips 29g x 12mm , 31g x 5 mm , T1 QL (200 EA per 30 days) 31g x 6 mm , 31g x 8 mm , 32g x 4 mm 1st tier unifine pentips plus 29g x 12mm , 31g x 5 T1 QL (200 EA per 30 days) mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm ACCU-CHEK TENDER 1 INFUSION KIT T1 QL (200 EA per 30 days) ADVOCATE INSULIN PEN NEEDLES 31G T1 QL (200 EA per 30 days) X 5 MM , 31G X 8 MM ADVOCATE INSULIN SYRINGE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G T1 QL (200 EA per 30 days) X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML anesthesia extension tubing T1 QL (200 EA per 30 days) anti-stick insulin syringe 29g x 1/2" 1 ml T1 QL (200 EA per 30 days)

62 Drug Status Notes ARGYLE EXTENSION TUBE 20" T1 QL (200 EA per 30 days) ASSURE DOSE CONTROL IN VITRO T1 SOLUTION NORMAL ASSURE ID INSULIN SAFETY SYR 29G X T1 QL (200 EA per 30 days) 1/2" 0.5 ML, 29G X 1/2" 1 ML aurora pen needles 29g x 12mm , 31g x 6 mm , T1 QL (200 EA per 30 days) 31g x 8 mm aurora unifine pentips 31g x 5 mm , 32g x 4 mm T1 QL (200 EA per 30 days) AUTOJECT 2 T1 QL (200 EA per 30 days) BD ANGIOCATH AUTOGUARD T1 QL (200 EA per 30 days) BD AUTOSHIELD 29G X 5MM , 29G X 8MM T1 QL (200 EA per 30 days) BD AUTOSHIELD DUO 30G X 5 MM T1 QL (200 EA per 30 days) BD ECLIPSE SYRINGE 25G X 5/8" 1 ML T1 QL (200 EA per 30 days) BD FIRST MIDCATH 18G/4FRX20CM T1 QL (200 EA per 30 days) BD FIRST MIDCATH 18G/4FRX20CM KIT T1 QL (200 EA per 30 days) BD FIRST MIDCATH 20G/3FRX20CM T1 QL (200 EA per 30 days) BD FIRST MIDCATH 20G/3FRX20CM KIT T1 QL (200 EA per 30 days) BD FIRST PICC 16G/5FRX65CM T1 QL (200 EA per 30 days) BD FIRST PICC 16G/5FRX65CM KIT T1 QL (200 EA per 30 days) BD FIRST PICC 18G/4FRX65CM T1 QL (200 EA per 30 days) BD FIRST PICC 18G/4FRX65CM KIT T1 QL (200 EA per 30 days) BD FIRST PICC 20G/3FRX65CM T1 QL (200 EA per 30 days) BD FIRST PICC 20G/3FRX65CM KIT T1 QL (200 EA per 30 days) BD FIRST PICC 22G/2.8FRX50CM T1 QL (200 EA per 30 days) BD FIRST PICC 26G/1.9FRX50CM T1 QL (200 EA per 30 days) BD FIRST PICC 26G/1.9FRX50CM KIT T1 QL (200 EA per 30 days) BD INSULIN SYR ULTRAFINE II 31G X T1 QL (200 EA per 30 days) 5/16" 0.5 ML BD INSULIN SYRINGE 25G X 1" 1 ML, 25G X 5/8" 1 ML, 26G X 1/2" 1 ML, 27G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, U-100 1 ML BD INSULIN SYRINGE HALF-UNIT 31G X T1 QL (200 EA per 30 days) 5/16" 0.3 ML BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML, 28G X 1/2" 0.3 ML, 28G X 1/2" 0.5 T1 QL (200 EA per 30 days) ML, 28G X 1/2" 1 ML BD INSULIN SYRINGE U/F 30G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 31G X 5/16" 0.3 ML BD INSULIN SYRINGE U-40 25G X 5/8" 1 T1 QL (200 EA per 30 days) ML

63 Drug Status Notes BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 31G X 5/16" 0.5 ML BD INTEGRA INSULIN SYRINGE 29G X T1 QL (200 EA per 30 days) 1/2" 1 ML BD INTEGRA SYRINGE 25G X 1" 1 ML, T1 QL (200 EA per 30 days) 25G X 5/8" 1 ML BD L-CATH 16G/5FR KIT T1 QL (200 EA per 30 days) BD L-CATH 16G/5FRX60CM T1 QL (200 EA per 30 days) BD L-CATH 18G/3.5FR KIT T1 QL (200 EA per 30 days) BD L-CATH 18G/3.5FRX60CM T1 QL (200 EA per 30 days) BD L-CATH 20G/2.6FR KIT T1 QL (200 EA per 30 days) BD L-CATH 20G/2.6FRX60CM T1 QL (200 EA per 30 days) BD L-CATH 20G/3FR KIT T1 QL (200 EA per 30 days) BD L-CATH 20G/3FRX60CM T1 QL (200 EA per 30 days) BD L-CATH 28G/1.2FRX25CM KIT T1 QL (200 EA per 30 days) BD L-CATH MIDLINE 18G/3.5FRX20 T1 QL (200 EA per 30 days) BD L-CATH MIDLINE 18G/3.5FRX20 KIT T1 QL (200 EA per 30 days) BD L-CATH MIDLINE 20G/3FRX20CM T1 QL (200 EA per 30 days) BD LUER-LOK SYRINGE 20G X 1" 1 ML, T1 QL (200 EA per 30 days) 25G X 5/8" 1 ML BD NEXIVA 18GX1.25" T1 QL (200 EA per 30 days) BD NEXIVA 18GX1.75" T1 QL (200 EA per 30 days) BD NEXIVA 20GX1" T1 QL (200 EA per 30 days) BD NEXIVA 20GX1.25" T1 QL (200 EA per 30 days) BD NEXIVA 20GX1.75" T1 QL (200 EA per 30 days) BD NEXIVA 22GX1" T1 QL (200 EA per 30 days) BD NEXIVA 24GX0.56" T1 QL (200 EA per 30 days) BD NEXIVA 24GX0.75" T1 QL (200 EA per 30 days) BD PEN NEEDLE MINI U/F 31G X 5 MM T1 QL (200 EA per 30 days) BD PEN NEEDLE NANO U/F 32G X 4 MM T1 QL (200 EA per 30 days) BD PEN NEEDLE ORIGINAL U/F 29G X T1 QL (200 EA per 30 days) 12.7MM BD PEN NEEDLE SHORT U/F 31G X 8 MM T1 QL (200 EA per 30 days) BD SAFETYGLIDE INSULIN SYRINGE 30G T1 QL (200 EA per 30 days) X 5/16" 0.5 ML, 31G X 5/16" 0.3 ML BD SAFETY-LOK INSULIN SYRINGE 29G T1 QL (200 EA per 30 days) X 1/2" 1 ML BD SAFETY-LOK SET T1 QL (200 EA per 30 days)

64 Drug Status Notes BD SAFETY-LOK VACUTAINER SET T1 QL (200 EA per 30 days) BD SAF-T E-Z SET T1 QL (200 EA per 30 days) BD SAF-T-INTIMA 18G X 1" KIT T1 QL (200 EA per 30 days) BD SAF-T-INTIMA 20GX1" T1 QL (200 EA per 30 days) BD SAF-T-INTIMA 22G X 0.75" KIT T1 QL (200 EA per 30 days) BD SAF-T-INTIMA 22GX3/4" T1 QL (200 EA per 30 days) BD SAF-T-INTIMA 24G X 0.75" KIT T1 QL (200 EA per 30 days) BD SAF-T-INTIMA 24GX3/4" T1 QL (200 EA per 30 days) BD SYRINGE/NEEDLE 25G X 5/8" 1 ML T1 QL (200 EA per 30 days) BD SYRINGE/NEEDLE SLIP TIP 26G X 5/8" T1 QL (200 EA per 30 days) 1 ML BD VACUTAINER SET T1 QL (200 EA per 30 days) CAREFINE PEN NEEDLES 29G X 12MM , 30G X 8 MM , 31G X 6 MM , 31G X 8 MM , T1 QL (200 EA per 30 days) 32G X 4 MM , 32G X 5 MM , 32G X 6 MM careone insulin syringe 30g x 1/2" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 31g x 5/16" 0.3 ml, T1 QL (200 EA per 30 days) 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml careone unifine pentips 29g x 12mm , 31g x 5 mm T1 QL (200 EA per 30 days) , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm careone unifine pentips plus 29g x 12mm , 31g x 5 T1 QL (200 EA per 30 days) mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm clickfine pen needles 31g x 6 mm , 31g x 8 mm , T1 QL (200 EA per 30 days) 32g x 4 mm COMFORT EZ INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X T1 QL (200 EA per 30 days) 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML COMFORT EZ PEN NEEDLES 31G X 5 MM T1 QL (200 EA per 30 days) , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM cool mist humidifier T1 CORNWALL METAL PIPETTING T1 QL (200 EA per 30 days) CURITY ALCOHOL PREPS PAD 70 % T1 denture adhesive cream T1 drug mart unifine pentips 29g x 12mm , 31g x 5 T1 QL (200 EA per 30 days) mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm drug mart unifine pentips plus 32g x 4 mm T1 QL (200 EA per 30 days) EASIVENT T1 QL (2 EA per 365 days) EASIVENT MASK LARGE T1 QL (2 EA per 365 days)

65 Drug Status Notes EASIVENT MASK MEDIUM T1 QL (2 EA per 365 days) EASIVENT MASK SMALL T1 QL (2 EA per 365 days) easy comfort insulin syringe 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 T1 QL (200 EA per 30 days) ml easy comfort pen needles 31g x 5 mm , 31g x 8 T1 QL (200 EA per 30 days) mm , 32g x 4 mm EASY TOUCH FLURINGE 25G X 1" 1 ML, T1 QL (200 EA per 30 days) 25G X 5/8" 1 ML EASY TOUCH INSULIN SAFETY SYR 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" T1 QL (200 EA per 30 days) 1 ML, 30G X 5/16" 0.5 ML EASY TOUCH INSULIN SYRINGE 27G X 1/2" 0.5 ML, 27G X 1/2" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X T1 QL (200 EA per 30 days) 1/2" 0.5 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML EASY TOUCH PEN NEEDLES 29G X 12MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , T1 QL (200 EA per 30 days) 32G X 4 MM , 32G X 5 MM , 32G X 6 MM EASY TOUCH SAFETY SYRINGE 25G X 1" T1 QL (200 EA per 30 days) 1 ML, 25G X 5/8" 1 ML elite-thin insulin syringe 28g x 5/16" 0.5 ml T1 QL (100 EA per 30 days) eql insulin syringe 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x T1 QL (200 EA per 30 days) 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml EXEL COMFORT POINT INSULIN SYR 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML FIFTY50 PEN NEEDLES 31G X 5 MM , 31G T1 QL (200 EA per 30 days) X 8 MM FIFTY50 SUPERIOR COMFORT SYR 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X T1 QL (200 EA per 30 days) 5/16" 1 ML fluid administration set T1 QL (200 EA per 30 days) freds pharmacy unifine pentip+ 31g x 5 mm , 31g T1 QL (200 EA per 30 days) x 8 mm freds pharmacy unifine pentips 32g x 4 mm T1 QL (200 EA per 30 days)

66 Drug Status Notes FREESTYLE CONTROL SOLUTION IN T1 VITRO LIQUID FREESTYLE PRECISION INS SYR 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" T1 QL (200 EA per 30 days) 0.5 ML, 31G X 5/16" 1 ML gauze sponge pad 4"x4" T1 global ease inject pen needles 29g x 12mm , 31g x T1 QL (200 EA per 30 days) 5 mm , 31g x 8 mm , 32g x 4 mm global inject ease insulin syr 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 1/2" 0.3 ml, 30g x 1/2" T1 QL (200 EA per 30 days) 0.5 ml, 30g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml GLUCOCARD EXPRESSION CONTROL IN T1 VITRO SOLUTION GLUCOPRO INSULIN SYRINGE 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G T1 QL (200 EA per 30 days) X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML gnp clickfine pen needles 31g x 6 mm , 31g x 8 T1 QL (200 EA per 30 days) mm gnp insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, T1 QL (200 EA per 30 days) 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml gnp ultra com insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x T1 QL (200 EA per 30 days) 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml H 468L TUBING T1 QL (200 EA per 30 days) healthwise mini pen needles 31g x 6 mm T1 QL (200 EA per 30 days) healthwise pen needles 29g x 12mm T1 QL (200 EA per 30 days) healthwise short pen needles 31g x 8 mm T1 QL (200 EA per 30 days) healthwise unifine pentips 32g x 4 mm T1 QL (200 EA per 30 days) healthy accents unifine pentip 29g x 12mm , 31g x T1 QL (200 EA per 30 days) 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm h-e-b incontrol pen needles 29g x 12mm , 31g x 5 T1 QL (200 EA per 30 days) mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm HM ULTICARE INSULIN SYRINGE 31G X T1 QL (200 EA per 30 days) 5/16" 0.3 ML HUBER INFUSION SET T1 QL (200 EA per 30 days) 67 Drug Status Notes HUMATROPEN FOR 12MG DEVICE T1 QL (200 EA per 30 days) HUMATROPEN FOR 24MG DEVICE T1 QL (200 EA per 30 days) HUMATROPEN FOR 6MG DEVICE T1 QL (200 EA per 30 days) infusion set T1 QL (200 EA per 30 days) infusion set 23" comfort T1 QL (200 EA per 30 days) inject-ease T1 QL (200 EA per 30 days) INJECT-EASE AUTOMATIC INJECTOR T1 QL (200 EA per 30 days) INSUFLON 25G X 0.71" T1 QL (200 EA per 30 days) insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 5/16" 1 T1 QL (200 EA per 30 days) ml insulin syringe 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 31g x T1 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml insulin syringe/needle 27g x 1/2" 0.5 ml, 28g x T1 QL (200 EA per 30 days) 1/2" 0.5 ml, 28g x 1/2" 1 ml insupen pen needles 32g x 4 mm T1 QL (200 EA per 30 days) INSUPEN SENSITIVE 32G X 6 MM , 32G X 8 T1 QL (200 EA per 30 days) MM INSUPEN ULTRAFIN 29G X 12MM , 30G X T1 QL (200 EA per 30 days) 8 MM , 31G X 6 MM , 31G X 8 MM INSYTE AUTOGUARD 14GX1.75" T1 QL (200 EA per 30 days) INSYTE AUTOGUARD 18GX1.16" T1 QL (200 EA per 30 days) INSYTE AUTOGUARD 20GX1" T1 QL (200 EA per 30 days) INSYTE AUTOGUARD 20GX1.16" T1 QL (200 EA per 30 days) INSYTE AUTOGUARD 22GX1" T1 QL (200 EA per 30 days) INSYTE AUTOGUARD 24GX3/4" T1 QL (200 EA per 30 days) KANGAROO BURETTE SET T1 QL (200 EA per 30 days) kinray insulin syringe 29g x 1/2" 0.5 ml, 31g x T1 QL (200 EA per 30 days) 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml kmart valu insulin syringe 29g u-100 0.5 ml, u- T1 QL (200 EA per 30 days) 100 1 ml kmart valu insulin syringe 30g u-100 0.3 ml, u- T1 QL (200 EA per 30 days) 100 0.5 ml, u-100 1 ml kroger insulin syringe 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, T1 QL (200 EA per 30 days) 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml kroger pen needles 29g x 12mm , 31g x 6 mm , T1 QL (200 EA per 30 days) 31g x 8 mm L606 TUBING T1 QL (200 EA per 30 days) L609 TUBING T1 QL (200 EA per 30 days) 68 Drug Status Notes leader insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" T1 QL (200 EA per 30 days) 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml LEADER UNIFINE PENTIPS 31G X 5 MM , T1 QL (200 EA per 30 days) 32G X 4 MM LEADER UNIFINE PENTIPS PLUS 31G X 5 T1 QL (200 EA per 30 days) MM , 31G X 8 MM , 32G X 4 MM LITETOUCH INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, T1 QL (200 EA per 30 days) 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML LITETOUCH PEN NEEDLES 29G X 12.7MM T1 QL (200 EA per 30 days) , 31G X 6 MM , 31G X 8 MM longs insulin syringe 31g x 5/16" 0.5 ml T1 QL (200 EA per 30 days) LTXF PRIM CNV PIN MICRODRIP T1 QL (200 EA per 30 days) LTXF PRIM IV SET/CNVT PIN T1 QL (200 EA per 30 days) LTXF SECONDARY/CNV PIN/32INC T1 QL (200 EA per 30 days) MAGELLAN INSULIN SAFETY SYR 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML medic insulin syringe 30g x 5/16" 0.3 ml, 30g x T1 QL (200 EA per 30 days) 5/16" 0.5 ml medicine shoppe pen needles 29g x 12mm , 31g x T1 QL (200 EA per 30 days) 6 mm , 31g x 8 mm MEDSAVER SYRINGE 25G X 5/8" 1 ML T1 QL (200 EA per 30 days) meijer pen needles 29g x 12mm , 31g x 6 mm , T1 QL (200 EA per 30 days) 31g x 8 mm MONOJECT INSULIN SYRINGE 25G X 5/8" 1 ML, 27G X 1/2" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X T1 QL (200 EA per 30 days) 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 1 ML, U-100 1 ML MONOJECT LIFESHIELD SYRINGE 18G X T1 QL (200 EA per 30 days) 1" 1 ML MONOJECT MAGELLAN SYRINGE 23G X T1 QL (200 EA per 30 days) 1" 1 ML, 25G X 1" 1 ML, 25G X 5/8" 1 ML

69 Drug Status Notes MONOJECT ULTRA COMFORT SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML MOORE MONO INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 T1 QL (200 EA per 30 days) ML, 29G X 1/2" 1 ML ms insulin syringe 31g x 5/16" 0.3 ml, 31g x 5/16" T1 QL (200 EA per 30 days) 0.5 ml, 31g x 5/16" 1 ml NERIA 29G INFUSION SET 10MM T1 QL (200 EA per 30 days) NERIA 29G INFUSION SET 6MM T1 QL (200 EA per 30 days) NERIA 29G INFUSION SET 8MM T1 QL (200 EA per 30 days) NERIA MULTI 27G 2X10MM T1 QL (200 EA per 30 days) NERIA MULTI 27G 3X10MM T1 QL (200 EA per 30 days) NERIA MULTI 27G 4X12MM T1 QL (200 EA per 30 days) NERIA SOFT 25G INFUSION 13MM T1 QL (200 EA per 30 days) NERIA SOFT 25G INFUSION 17MM T1 QL (200 EA per 30 days) NORDIPEN 5 INJECTION DEVICE T1 QL (200 EA per 30 days) NORDIPEN DELIVERY SYSTEM T1 QL (200 EA per 30 days) NOVOFINE 30G X 8 MM , 32G X 6 MM T1 QL (200 EA per 30 days) NOVOFINE AUTOCOVER 30G X 8 MM T1 QL (200 EA per 30 days) NOVOFINE PLUS 32G X 4 MM T1 QL (200 EA per 30 days) NOVOPEN ECHO DEVICE T1 QL (200 EA per 30 days) NOVOTWIST 32G X 5 MM T1 QL (200 EA per 30 days) OMNIFLEX DIAPHRAGM VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM OMNITROPE PEN 10 INJ DEVICE T1 QL (200 EA per 30 days) OMNITROPE PEN 5 INJ DEVICE T1 QL (200 EA per 30 days) ONETOUCH DELICA LANCETS 30G T1 ONETOUCH DELICA LANCETS 33G T1 ONETOUCH ULTRA CONTROL IN VITRO T1 SOLUTION ONETOUCH VERIO SOLUTION IN VITRO T1 QL (1 EA per 365 days) pc unifine pentips 29g x 12mm , 31g x 5 mm , 31g T1 QL (200 EA per 30 days) x 6 mm , 31g x 8 mm pen needles 1/2" 29g x 12mm T1 QL (200 EA per 30 days) pen needles 29g x 12mm , 31g x 6 mm T1 QL (200 EA per 30 days) pen needles 3/16" 31g x 5 mm T1 QL (200 EA per 30 days) pen needles 5/16" 30g x 8 mm , 31g x 8 mm T1 QL (200 EA per 30 days) plastic adapter , 1 ml T1 QL (200 EA per 30 days) 70 Drug Status Notes PRECISION SUREDOSE PLUS SYR 29G X T1 QL (200 EA per 30 days) 1/2" 0.3 ML, 29G X 1/2" 1 ML PRECISION SURE-DOSE SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.5 T1 QL (200 EA per 30 days) ML, 30G X 3/8" 0.5 ML preferred plus insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 T1 QL (200 EA per 30 days) ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml preferred plus unifine pentips 29g x 12mm , 31g x T1 QL (200 EA per 30 days) 5 mm , 31g x 6 mm , 31g x 8 mm , 32g x 4 mm PRODIGY INSULIN SYRINGE 28G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML px extra short pen needles 31g x 6 mm T1 QL (200 EA per 30 days) px insulin syringe 30g x 1/2" 0.3 ml, 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 31g x 5/16" 0.3 ml, 31g x T1 QL (200 EA per 30 days) 5/16" 0.5 ml, 31g x 5/16" 1 ml px mini pen needles 31g x 5 mm T1 QL (200 EA per 30 days) px pen needle 29g x 12mm , 31g x 8 mm T1 QL (200 EA per 30 days) qc pen needles 29g x 12mm , 31g x 6 mm , 31g x 8 T1 QL (200 EA per 30 days) mm qc unifine pentips 32g x 4 mm T1 QL (200 EA per 30 days) ra insulin syringe 29g x 1/2" 0.5 ml, 29g x 1/2" 1 T1 QL (200 EA per 30 days) ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml ra pen needles 31g x 5 mm , 31g x 8 mm T1 QL (200 EA per 30 days) RELI-ON INSULIN SYRINGE 29G 0.3 ML, T1 QL (200 EA per 30 days) 29G 0.5 ML, 29G X 1/2" 1 ML RELION INSULIN SYRINGE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, T1 QL (200 EA per 30 days) 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML RELI-ON INSULIN SYRINGE 30G 1 ML T1 QL (100 EA per 30 days) RELION INSULIN SYRINGE 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 T1 ML RELION MINI PEN NEEDLES 31G X 6 MM T1 QL (200 EA per 30 days) RELION PEN NEEDLES 29G X 12MM , 31G T1 QL (200 EA per 30 days) X 8 MM , 32G X 4 MM RELION SHORT PEN NEEDLES 31G X 8 T1 QL (200 EA per 30 days) MM SAFELET IV CATHETER T1 QL (200 EA per 30 days) SAFESNAP INSULIN SYRINGE 28G X 1/2" 1 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, T1 QL (200 EA per 30 days) 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML 71 Drug Status Notes sb insulin syringe 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x T1 QL (200 EA per 30 days) 5/16" 1 ml scalp vein set T1 QL (200 EA per 30 days) schnucks insulin syringe 29g x 1/2" 0.5 ml, 30g x T1 QL (200 EA per 30 days) 5/16" 0.5 ml SHOPKO UNIFINE PENTIPS 29G X 12MM , T1 QL (200 EA per 30 days) 31G X 5 MM , 31G X 8 MM , 32G X 4 MM sm insulin syringe 31g x 5/16" 1 ml T1 QL (200 EA per 30 days) solution transfer device T1 QL (200 EA per 30 days) sure comfort insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 1/2" 0.3 ml, 30g x 1/2" T1 QL (200 EA per 30 days) 0.5 ml, 30g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml sure comfort pen needles 30g x 8 mm , 31g x 5 T1 QL (200 EA per 30 days) mm , 31g x 8 mm , 32g x 4 mm SURE-FINE PEN NEEDLES 29G X 12.7MM , T1 QL (200 EA per 30 days) 31G X 5 MM , 31G X 8 MM SURE-JECT INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X T1 QL (200 EA per 30 days) 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML SURE-T INFUSION SET 18" T1 QL (200 EA per 30 days) SURE-T INFUSION SET 23" T1 QL (200 EA per 30 days) SURE-T INFUSION SET 32" T1 QL (200 EA per 30 days) surgical dressing pad 5"x9" T1 syringe luer slip 25g x 5/8" 1 ml, 26g x 3/8" 1 ml T1 QL (200 EA per 30 days) todays health mini pen needles 31g x 6 mm T1 QL (200 EA per 30 days) todays health pen needles 29g x 12mm T1 QL (200 EA per 30 days) todays health short pen needle 31g x 8 mm T1 QL (200 EA per 30 days) topcare clickfine pen needles 31g x 6 mm , 31g x T1 QL (200 EA per 30 days) 8 mm topcare ultra comfort ins syr 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g T1 QL (200 EA per 30 days) x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml

72 Drug Status Notes TRUEPLUS INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X T1 QL (200 EA per 30 days) 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML ULTICARE INSULIN SAFETY SYR 29G X T1 QL (200 EA per 30 days) 1/2" 0.5 ML, 29G X 1/2" 1 ML ULTICARE INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 T1 QL (200 EA per 30 days) ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML ULTICARE MICRO PEN NEEDLES 32G X 4 T1 QL (200 EA per 30 days) MM ULTICARE MINI PEN NEEDLES 31G X 6 T1 QL (200 EA per 30 days) MM ULTICARE PEN NEEDLES 29G X 12.7MM T1 QL (200 EA per 30 days) ULTICARE SHORT PEN NEEDLES 31G X 8 T1 QL (200 EA per 30 days) MM ULTICARE SYRINGE 22G X 1-1/2" 1 ML T1 QL (200 EA per 30 days) ULTILET INSULIN SYRINGE SHORT 30G T1 X 5/16" 0.3 ML, 30G X 5/16" 1 ML ULTILET INSULIN SYRINGE SHORT 30G X 5/16" 0.5 ML, 31G X 5/16" 0.3 ML, 31G X T1 QL (200 EA per 30 days) 5/16" 0.5 ML, 31G X 5/16" 1 ML ULTILET PEN NEEDLE 31G X 8 MM T1 QL (200 EA per 30 days) ultra comfort insulin syringe 30g x 5/16" 0.3 ml T1 QL (200 EA per 30 days) ultra-comfort insulin syringe 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 29g x 1/2" 0.3 ml, 29g x 1/2" 0.5 ml, 29g x 1/2" 1 ml, 30g x 5/16" 0.3 ml, 30g x T1 QL (200 EA per 30 days) 5/16" 0.5 ml, 30g x 5/16" 1 ml, 31g x 5/16" 0.3 ml, 31g x 5/16" 0.5 ml, 31g x 5/16" 1 ml ULTRA-THIN II INS SYR SHORT 31G X T1 QL (200 EA per 30 days) 5/16" 1 ML UNIFINE PENTIPS 29G X 12MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 T1 QL (200 EA per 30 days) MM UNIFINE PENTIPS PLUS 29G X 12MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , T1 QL (200 EA per 30 days) 32G X 4 MM VACUTAINER TUBING T1 QL (200 EA per 30 days)

73 Drug Status Notes value health insulin syringe 29g x 1/2" 0.5 ml, T1 QL (200 EA per 30 days) 29g x 1/2" 1 ml valumark pen needles 29g x 12mm , 31g x 6 mm , T1 QL (200 EA per 30 days) 31g x 8 mm VANISHPOINT 18GX1-1/4" FEP T1 QL (200 EA per 30 days) VANISHPOINT 18GX1-1/4" PUR T1 QL (200 EA per 30 days) VANISHPOINT 20GX1-1/4" FEP T1 QL (200 EA per 30 days) VANISHPOINT 20GX1-1/4" PUR T1 QL (200 EA per 30 days) VANISHPOINT 22GX1" FEP T1 QL (200 EA per 30 days) VANISHPOINT 22GX1" PUR T1 QL (200 EA per 30 days) VANISHPOINT 24GX3/4" FEP T1 QL (200 EA per 30 days) VANISHPOINT 24GX3/4" PUR T1 QL (200 EA per 30 days) VANISHPOINT INSULIN SYRINGE 29G X T1 QL (200 EA per 30 days) 1/2" 1 ML, 30G X 1/2" 0.5 ML VANISHPOINT SYRINGE 25G X 1" 1 ML T1 QL (200 EA per 30 days) VIDA MIA UNIFINE PENTIPS 29G X 12MM T1 QL (200 EA per 30 days) , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM vp insulin syringe 29g x 1/2" 0.3 ml T1 QL (200 EA per 30 days) V-R MONO INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, T1 QL (200 EA per 30 days) 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML warm mist vaporizer T1 wegmans unifine pentips plus 31g x 5 mm , 31g x T1 QL (200 EA per 30 days) 6 mm , 31g x 8 mm , 32g x 4 mm WIDE-SEAL DIAPHRAGM 60 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % WIDE-SEAL DIAPHRAGM 65 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % WIDE-SEAL DIAPHRAGM 70 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % WIDE-SEAL DIAPHRAGM 75 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % WIDE-SEAL DIAPHRAGM 80 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % WIDE-SEAL DIAPHRAGM 85 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % WIDE-SEAL DIAPHRAGM 90 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % WIDE-SEAL DIAPHRAGM 95 VAGINAL T1 GR-F; QL (1 EA per 365 days) DIAPHRAGM 2 % *Migraine Products* naratriptan hcl oral tablet 1 mg, 2.5 mg T1 ST; QL (9 EA per 30 days) 74 Drug Status Notes rizatriptan benzoate oral tablet 10 mg, 5 mg T1 QL (12 EA per 30 days) rizatriptan benzoate oral tablet dispersible 10 mg, T1 QL (12 EA per 30 days) 5 mg sumatriptan succinate oral tablet 100 mg, 25 mg, T1 QL (9 EA per 30 days) 50 mg zolmitriptan oral tablet 2.5 mg, 5 mg T1 ST zolmitriptan oral tablet dispersible 2.5 mg, 5 mg T1 ST *Minerals & Electrolytes* cal/mag oral tablet 200-100 mg T1 CALCET CREAMY BITES ORAL TABLET T1 CHEWABLE 500-400 MG-UNIT cal-citrate plus vitamin d oral tablet 250-100 mg- T1 unit calcium + d3 oral tablet 600-200 mg-unit T1 calcium 1000 + d oral tablet 1000-800 mg-unit T1 calcium 500 + d oral tablet 500-125 mg-unit T1 calcium 500/d oral tablet 500-200 mg-unit T1 calcium 500/d oral tablet chewable 500-400 mg- T1 unit calcium 500+d high potency oral tablet 500-400 T1 mg-unit calcium 500+d oral tablet 500-200 mg-unit, 500- T1 400 mg-unit calcium 600/vitamin d oral tablet chewable 600- T1 400 mg-unit calcium 600+d oral tablet 600-200 mg-unit, 600- T1 400 mg-unit calcium 600+d3 oral tablet 600-400 mg-unit, T1 600-800 mg-unit calcium carbonate oral suspension 1250 (500 ca) T1 mg/5ml calcium carbonate oral tablet 1250 (500 ca) mg T1 calcium carbonate-vitamin d oral capsule 600- T1 200 mg-unit calcium citrate + d oral tablet 315-200 mg-unit T1 calcium citrate + d3 oral tablet 250-200 mg-unit, T1 315-250 mg-unit calcium citrate malate-vit d oral tablet 250-100 T1 mg-unit calcium citrate oral granules 760 mg/3.5gm T1 calcium citrate oral tablet 200 mg, 250 mg, 950 T1 (200 ca) mg 75 Drug Status Notes calcium citrate+d3 petites oral tablet 200-250 T1 mg-unit calcium citrate-vitamin d oral tablet 250-50 mg- T1 unit calcium citrate-vitamin d3 oral liquid 1000-400 T1 calcium magnesium 750 oral tablet 300-300 mg T1 calcium oral tablet chewable 500-100 mg-unit, T1 600-400 mg-unit calcium plus vitamin d oral capsule 300-100 mg- T1 unit, 500-50 mg-unit calcium/vitamin d3 gummies oral tablet chewable T1 200-200 mg-unit calcium-carb 600 + d oral tablet 600-125 mg-unit T1 calcium-magnesium oral tablet 250-125 mg, 250- T1 155 mg, 500-250 mg calcium-vitamin d oral tablet 600-200 mg-unit T1 calcium-vitamin d3 oral capsule 600-400 mg-unit, T1 600-500 mg-unit calcium-vitamin d3 oral tablet 250-125 mg-unit T1 cal-mag aspartate oral tablet 333.33-167 mg T1 CAL-MAG CHELA-MAX ORAL CAPSULE T1 70-83 MG calmag thins oral tablet 200-50 mg T1 CAL-QUICK ORAL LIQUID 500-400 MG- T1 UNT/5ML chelated magnesium oral tablet 100 mg T1 cvs calcium oral tablet chewable 250-400 mg-unit T1 cvs oyster shell calcium+vit d oral tablet 500-125 T1 mg-unit elite ca/mg oral tablet 100-50 mg T1 eql calcium/vitamin d oral capsule 600-100 mg- T1 unit eql vitamin d-3 high potency oral tablet 115-2000 T1 mg-unit gnp calcium 500 +d3 oral tablet 500-600 mg-unit T1 KLOR-CON M15 ORAL TABLET T1 EXTENDED RELEASE 15 MEQ K-PHOS ORAL TABLET 500 MG T1 liquid calcium with d3 oral capsule 600-1000 mg- T1 unit m2 magnesium oral capsule 100 mg T1

76 Drug Status Notes MAG64 ORAL TABLET DELAYED T1 RELEASE 64 MG mag-g oral tablet 500 (27 mg) mg T1 MAGINEX DS ORAL PACKET 1230 MG T1 MAGINEX ORAL TABLET DELAYED T1 RELEASE 615 MG magnesium aspartate oral tablet 65 mg T1 magnesium carbonate oral powder 250 mg/gm T1 magnesium carbonate powder T1 magnesium chloride crystals T1 magnesium chloride powder T1 magnesium citrate oral tablet 100 mg T1 magnesium gluconate oral tablet 27.5 mg, 30 mg, T1 500 mg, 550 mg magnesium lactate oral tablet extended release 84 T1 mg (7meq) magnesium oral capsule 300 mg, 500 mg T1 magnesium oral tablet 200 mg, 250 mg, 30 mg, T1 400 mg magnesium oxide -mg supplement oral capsule T1 400 mg magnesium oxide -mg supplement oral tablet 250 T1 mg magnesium oxide oral powder T1 magnesium oxide oral tablet 400 (240 mg) mg, T1 400 (241.3 mg) mg, 500 mg magnesium sulfate in d5w intravenous solution 1- T1 5 gm/100ml-% magnesium sulfate injection solution 50 % T1 magnesium sulfate intravenous solution 2 gm/50ml, 20 gm/500ml, 4 gm/100ml, 4 gm/50ml, T1 40 gm/1000ml magnesium sulfate oral capsule 70 mg T1 MAGONATE ORAL LIQUID 54 (MAG T1 EQUIV) MG/5ML ORAZINC ORAL TABLET 110 MG T1 OSTEO-PORETICAL ORAL TABLET 600- T1 1000 MG-UNIT OSTIGEN ORAL 350 MG T1 OYSCO 500+D ORAL TABLET T1 CHEWABLE 500-600 MG-UNIT

77 Drug Status Notes oyster shell calcium plus d oral tablet 333-133 T1 mg-unit oyster shell calcium/d oral tablet 250-125 mg- T1 unit, 250-250 mg-unit parva-cal oral tablet 250-100 mg-unit, 500-200 T1 mg-unit PEDIALYTE ORAL SOLUTION T1 PHOSPHA 250 NEUTRAL ORAL TABLET T1 155-852-130 MG phosphorus supplement oral packet 280-160-250 T1 mg pot bicarb-pot chloride oral tablet effervescent 25 T1 meq potassium bicarbonate oral tablet effervescent 25 T1 meq potassium chloride crys er oral tablet extended T1 release 10 meq, 15 meq, 20 meq potassium chloride er oral capsule extended T1 release 10 meq, 8 meq potassium chloride er oral tablet extended release T1 10 meq, 20 meq, 8 meq potassium chloride oral packet 20 meq T1 potassium chloride oral solution 20 meq/15ml T1 (10%) ra calcium hi-cal/vitamin d oral tablet 500-125 T1 mg-unit ra calcium-boron oral tablet 500-1.5 mg T1 sodium chloride flush intravenous solution 0.9 % T1 sodium chloride injection solution 0.9 % T1 sodium chloride intravenous solution 0.9 % T1 sodium chloride oral tablet 1 gm T1 QL (30 ML per 30 days); AL (Max sodium fluoride oral solution 1.1 (0.5 f) mg/ml T1 10 Years) sodium fluoride oral tablet chewable 1.1 (0.5 f) QL (30 EA per 30 days); AL (Max T1 mg, 2.2 (1 f) mg 10 Years) UPCAL D ORAL PACKET 500-500 MG- T1 UNIT UPCAL D ORAL POWDER 500-500 MG- T1 UNT/5GM VITALINE BUFFERED ZINC-220 ORAL TABLET EXTENDED RELEASE 220 (50 ZN) T1 MG

78 Drug Status Notes yl oyster shell calcium/d oral tablet 250-125 mg- T1 unit ZINC 15 ORAL TABLET 66 MG T1 zinc sulfate granules T1 zinc sulfate intravenous solution 1 mg/ml, 5 T1 mg/ml zinc sulfate oral capsule 220 (50 zn) mg T1 zinc sulfate oral tablet 140 (50 zn) mg, 220 (50 T1 zn) mg zinc sulfate powder T1 *Miscellaneous Therapeutic Classes* ARGYLE STERILE WATER IRRIGATION T1 SOLUTION azathioprine oral tablet 50 mg T1 CELLCEPT ORAL SUSPENSION T1 PA RECONSTITUTED 200 MG/ML cyclosporine modified oral capsule 100 mg, 25 T1 mg, 50 mg cyclosporine modified oral solution 100 mg/ml T1 cyclosporine oral capsule 100 mg, 25 mg T1 GENGRAF ORAL CAPSULE 100 MG, 25 T1 MG GENGRAF ORAL SOLUTION 100 MG/ML T1 KIONEX ORAL POWDER T1 mycophenolate mofetil oral capsule 250 mg T1 mycophenolate mofetil oral suspension T1 PA reconstituted 200 mg/ml mycophenolate mofetil oral tablet 500 mg T1 sodium polystyrene sulfonate oral powder T1 sterile water for irrigation irrigation solution T1 tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg T1 *Mouth/Throat/Dental Agents* ANBESOL MOUTH/THROAT LIQUID 10 % T1 BENZ-O-STHETIC MOUTH/THROAT T1 SOLUTION 20 % BENZ-O-STHETIC MOUTH/THROAT T1 SWAB 20 % chlorhexidine gluconate mouth/throat solution T1 0.12 % clotrimazole mouth/throat lozenge 10 mg T1

79 Drug Status Notes DENTS TOOTHACHE MOUTH/THROAT T1 GUM 20 % GEL-TIN DENTAL GEL 0.4 % T1 lidocaine hcl mouth/throat solution 4 % T1 lidocaine viscous mouth/throat solution 2 % T1 LITTLE TEETHERS PAIN RELIEF T1 MOUTH/THROAT SWAB 7.5 % nystatin mouth/throat suspension 100000 unit/ml T1 ORA-FILM MOUTH/THROAT STRIP 6 % T1 oral analgesic max st mouth/throat gel 20 % T1 oral analgesic max st mouth/throat liquid 20 % T1 oral anesthetic mouth/throat paste 20 % T1 ORAMAGIC PLUS MOUTH/THROAT T1 SUSPENSION RECONSTITUTED 10 % PERIOMED MOUTH/THROAT T1 CONCENTRATE 0.63 % pilocarpine hcl oral tablet 5 mg T1 ra baby care oral pain relief mouth/throat gel 7.5 T1 % sf 5000 plus dental cream 1.1 % T1 triamcinolone acetonide mouth/throat paste 0.1 % T1 *Multivitamins* adult gummy oral tablet chewable T1 antioxidant formula sg oral capsule extended T1 release AQUADEKS ORAL LIQUID T1 AL (Max 9 Years) ATABEX EC ORAL TABLET DELAYED T1 GR-F RELEASE 29-1 MG ATABEX ORAL TABLET CHEWABLE 18- T1 GR-F 0.8 MG b-complex balanced oral tablet T1 b-complex/vitamin c oral tablet T1 biovol oral syrup T1 BRAINSTRONG PRENATAL ORAL 33-0.8 T1 GR-F & 350 MG CENTRUM SPECIALIST PRENATAL T1 GR-F ORAL 27-0.8 & 200 MG child chewable vitamins/iron oral tablet chewable T1 AL (Max 9 Years) childrens gummies oral tablet chewable T1 AL (Max 9 Years)

80 Drug Status Notes childrens multivitamin oral tablet chewable 60 T1 AL (Max 9 Years) mg CLINICAL NUTRIENTS PRENATAL ORAL T1 GR-F TABLET 7.5-0.2 MG COMPLETE FORMULATION PEDIATRIC T1 AL (Max 9 Years) ORAL SOLUTION 45 MG/0.5ML complete natal dha oral 29-1-200 & 250 mg T1 GR-F complete prenatal/dha oral 30-0.975 & 300 mg T1 GR-F CORVITA ORAL TABLET 1.25 MG T1 cvs prenatal gummy oral tablet chewable 0.4- T1 GR-F 113.5 mg daily multiple vitamins/min oral tablet T1 DAILY PAK MAXIMUM MULTIVITAMIN T1 ORAL daily vitamin plus oral capsule T1 daily-vitamin oral tablet T1 DIALYVITE SUPREME D ORAL TABLET 3 T1 MG ELDERTONIC ORAL ELIXIR T1 eql childrens multivitamins oral tablet chewable T1 eql gummies childrens oral tablet chewable 30 T1 AL (Max 9 Years) mg FLINTSTONES TODDLER ORAL TABLET T1 CHEWABLE 40 MG GR-F; QL (30 EA per 30 days); FOLGARD OS ORAL TABLET 500-1.1 MG T1 AL (Min 14 Years and Max 50 Years) HEALTHY MAMA BE WELL ROUNDED T1 GR-F ORAL THERAPY PACK 28-0.8 & 450 MG HONEY BEARS W/IRON-ZINC ORAL T1 AL (Max 9 Years) TABLET CHEWABLE 30-200-3 kpn prenatal oral tablet 0.1 mg T1 GR-F MEGA MULTIVITAMIN ORAL POWDER T1 multi-delyn oral liquid T1 AL (Max 9 Years) multi-delyn/iron oral liquid T1 multivitamins oral tablet chewable T1 MYKIDZ IRON ORAL SUSPENSION 10 T1 MG/2ML MYNATAL ORAL CAPSULE T1 GR-F mynatal plus oral tablet T1 GR-F mynate 90 plus oral tablet extended release T1 GR-F

81 Drug Status Notes NANOVM T/F ORAL LIQUID T1 AL (Max 9 Years) NANOVM T/F ORAL POWDER T1 NATALVIT ORAL TABLET T1 GR-F OBSTETRIX DHA ORAL 29-1 & 387 MG T1 GR-F OBSTETRIX EC ORAL TABLET 29-1 MG T1 GR-F O-CAL PRENATAL ORAL TABLET T1 GR-F ONE-A-DAY WOMENS PRENATAL ORAL T1 GR-F 28-0.8 & 223 MG pa prenatal formula oral tablet 9-0.5 mg T1 GR-F PERRY PRENATAL ORAL CAPSULE 13.5- T1 GR-F 0.4 MG poly vitamin oral tablet chewable T1 AL (Max 9 Years) polyvitamin oral solution 35 mg/ml T1 AL (Max 9 Years) polyvitamin/iron oral solution 10 mg/ml T1 AL (Max 9 Years) PR NATAL 400 ORAL 29-1-200 & 400 MG T1 GR-F PR NATAL 430 ORAL 29-1-200 & 430 MG T1 GR-F PRENATA ORAL TABLET CHEWABLE 29- T1 GR-F 1 MG prenatabs fa oral tablet T1 GR-F prenatal 19 oral tablet 29-1 mg T1 GR-F prenatal 19 oral tablet chewable 29-1 mg T1 GR-F prenatal complete oral tablet 14-0.4 mg T1 GR-F prenatal formula a-free oral tablet 9-0.267 mg T1 GR-F prenatal formula oral capsule 28-0.8-235 mg T1 GR-F prenatal multi +dha oral capsule 27-0.8-228 mg T1 GR-F PRENATAL MULTIVITAMIN + DHA ORAL T1 GR-F 28-0.8 & 200 MG prenatal oral tablet 27-0.8 mg, 28-0.8 mg, 6.75- T1 GR-F 0.2 mg prenatal plus iron oral tablet 29-1 mg T1 GR-F prenatal plus oral tablet 27-1 mg T1 GR-F prenatal vitamins oral tablet 0.8 mg T1 GR-F prenatal/omega-3/fa/iron oral capsule 28-0.8-530 T1 GR-F mg prenatal+dha oral 28-0.975 & 200 mg T1 GR-F PRENATAL-U ORAL CAPSULE 106.5-1 MG T1 GR-F profe forte oral capsule 155-1 mg T1 GR-F purefe ob plus oral capsule 162-115.2-1 mg T1 GR-F qc childrens vitamins/extra c oral tablet chewable T1 AL (Max 9 Years)

82 Drug Status Notes ra one daily oral 28-0.8 & 440 mg T1 GR-F RENAL ORAL CAPSULE 1 MG T1 SCOOBY-DOO ONE A DAY ORAL TABLET T1 CHEWABLE stress formula/iron oral tablet T1 stress formula/zinc oral tablet T1 STUART ONE ORAL CAPSULE 27-0.8-200 T1 GR-F MG super b complex/vitamin c oral tablet T1 SUPERVITE EC ORAL TABLET DELAYED T1 RELEASE 1 MG SYNATEK ORAL CAPSULE 1.25 MG T1 TARON-BC ORAL 20-1 MG & 2 X 25 MG T1 GR-F THERANATAL COMPLETE ORAL 27-1 & T1 GR-F 300 MG therapeutic liquid oral solution T1 trinatal rx 1 oral tablet 60-1 mg T1 GR-F tri-vit/fluoride oral solution 0.25 mg/ml T1 AL (Max 9 Years) tri-vitamin/fluoride oral solution 0.5 mg/ml T1 AL (Max 9 Years) UDAMIN SP ORAL TABLET 1 MG T1 ultra-mega oral tablet extended release T1 VINATE II ORAL TABLET 29-1 MG T1 GR-F VINATE M ORAL TABLET 27-1 MG T1 GR-F virt-vite gt oral tablet 90-1 mg T1 GR-F vitamin c-electrolytes oral packet T1 zinc oral lozenge T1 *Musculoskeletal Therapy Agents* baclofen oral tablet 10 mg, 20 mg T1 chlorzoxazone oral tablet 500 mg T1 cyclobenzaprine hcl oral tablet 10 mg, 5 mg T1 methocarbamol oral tablet 500 mg, 750 mg T1 tizanidine hcl oral tablet 2 mg, 4 mg T1 QL (90 EA per 30 days) *Nasal Agents - Systemic And Topical* allergy spray 24 hour aerosol 55 mcg/act nasal T1 QL (16.9 ML per 30 days) 55 mcg/act anefrin spray nasal solution 0.05 % T1 childrens silfedrine oral liquid 15 mg/5ml T1 cromolyn sodium nasal aerosol solution 5.2 T1 mg/act

83 Drug Status Notes cvs nasal allergy spray aerosol 55 mcg/act nasal T1 QL (16.9 ML per 30 days) 55 mcg/act eq nasal allergy aerosol 55 mcg/act nasal 55 T1 QL (16.9 ML per 30 days) mcg/act fluticasone propionate nasal suspension 50 T1 QL (16 GM per 30 days) mcg/act gnp 24 hour nasal allergy aerosol 55 mcg/act T1 QL (16.9 ML per 30 days) nasal 55 mcg/act goodsense nasal allergy spray aerosol 55 mcg/act T1 QL (16.9 ML per 30 days) nasal 55 mcg/act ipratropium bromide nasal solution 0.03 % T1 QL (30 ML per 30 days) ipratropium bromide nasal solution 0.06 % T1 QL (15 ML per 30 days) NASACORT ALLERGY 24HR NASAL T1 AEROSOL 55 MCG/ACT nasal allergy 24 hour aerosol 55 mcg/act nasal T1 QL (16.9 ML per 30 days) 55 mcg/act nasal decongestant oral liquid 30 mg/5ml T1 nasal decongestant oral syrup 30 mg/5ml T1 NEXAFED ORAL TABLET ABUSE- T1 DETERRENT 30 MG pseudoephedrine hcl er oral tablet extended T1 release 12 hour 120 mg pseudoephedrine hcl oral tablet 30 mg, 60 mg T1 ra nasal allergy aerosol 55 mcg/act nasal 55 T1 QL (16.9 ML per 30 days) mcg/act RHINOCORT ALLERGY NASAL T1 SUSPENSION 32 MCG/ACT saline nasal spray nasal solution 0.65 % T1 QL (90 ML per 30 days) triamcinolone acetonide aerosol 55 mcg/act nasal T1 QL (16.9 GM per 30 days) (otc) 55 mcg/act *Neuromuscular Agents* riluzole oral tablet 50 mg T1 QL (60 EA per 30 days) *Ophthalmic Agents* advanced lubricant ophthalmic solution 0.05-1 % T1 artificial tears ophthalmic ointment 83-15 % T1 artificial tears ophthalmic solution 0.1-0.3 %, 0.2-0.2-1 %, 0.4 %, 1 %, 1-0.3 %, 1.4 %, 5-6 T1 mg/ml atropine sulfate ophthalmic ointment 1 % T1 atropine sulfate ophthalmic solution 1 % T1 azelastine hcl ophthalmic solution 0.05 % T1

84 Drug Status Notes bacitracin ophthalmic ointment 500 unit/gm T1 bacitracin-polymyxin b ophthalmic ointment 500- T1 10000 unit/gm bacitra-neomycin-polymyxin-hc ophthalmic T1 ointment 1 % BESIVANCE OPHTHALMIC SUSPENSION T1 0.6 % betaxolol hcl ophthalmic solution 0.5 % T1 bimatoprost ophthalmic solution 0.03 % T1 ST; QL (5 ML per 30 days) BLEPHAMIDE S.O.P. OPHTHALMIC T1 OINTMENT 10-0.2 % BLINK TEARS OPHTHALMIC GEL 0.25 % T1 BLINK TEARS OPHTHALMIC SOLUTION T1 0.25 % brimonidine tartrate ophthalmic solution 0.2 % T1 carteolol hcl ophthalmic solution 1 % T1 CILOXAN OPHTHALMIC OINTMENT 0.3 T1 % ciprofloxacin hcl ophthalmic solution 0.3 % T1 cromolyn sodium ophthalmic solution 4 % T1 cvs lubricant drops ophthalmic gel 0.25-0.3 %, 1 T1 % CYCLOMYDRIL OPHTHALMIC T1 SOLUTION 0.2-1 % cyclopentolate hcl ophthalmic solution 1 % T1 dexamethasone sodium phosphate ophthalmic T1 solution 0.1 % diclofenac sodium ophthalmic solution 0.1 % T1 dorzolamide hcl ophthalmic solution 2 % T1 dorzolamide hcl-timolol mal ophthalmic solution T1 22.3-6.8 mg/ml epinastine hcl ophthalmic solution 0.05 % T1 eq lubricating eye drops ophthalmic solution 0.5- T1 0.9 % erythromycin ophthalmic ointment 5 mg/gm T1 eye allergy relief ophthalmic solution 0.025-0.3 T1 %, 0.027-0.315 % eye drops allergy relief ophthalmic solution 0.05- T1 0.25 % eye drops ophthalmic solution 0.012-0.2 % T1 eye lubricant ophthalmic ointment T1

85 Drug Status Notes FLAREX OPHTHALMIC SUSPENSION 0.1 T1 % fluorometholone ophthalmic suspension 0.1 % T1 flurbiprofen sodium ophthalmic solution 0.03 % T1 FML OPHTHALMIC OINTMENT 0.1 % T1 GENTAK OPHTHALMIC OINTMENT 0.3 T1 % gentamicin sulfate ophthalmic solution 0.3 % T1 GENTEAL MILD OPHTHALMIC T1 SOLUTION 0.2 % GONIOTAIRE OPHTHALMIC SOLUTION T1 2.5 % HOMATROPAIRE OPHTHALMIC T1 SOLUTION 5 % HYPOTEARS OPHTHALMIC SOLUTION 1- T1 1 % ISOPTO CARBACHOL OPHTHALMIC T1 SOLUTION 3 % ISOPTO HOMATROPINE OPHTHALMIC T1 SOLUTION 2 % ISOPTO TEARS OPHTHALMIC T1 SOLUTION 0.5 % ketorolac tromethamine ophthalmic solution 0.4 T1 %, 0.5 % ketotifen fumarate ophthalmic solution 0.025 % T1 QL (5 ML per 30 days) latanoprost ophthalmic solution 0.005 % T1 QL (5 ML per 30 days) levobunolol hcl ophthalmic solution 0.25 % T1 levobunolol hcl ophthalmic solution 0.5 % T1 QL (5 ML per 18 days) lubricant eye drops ophthalmic solution 0.4-0.3 T1 %, 0.5 %, 0.6 % metipranolol ophthalmic solution 0.3 % T1 moxifloxacin hcl ophthalmic solution 0.5 % T1 multi-purpose solution solution T1 MURO 128 OPHTHALMIC SOLUTION 2 % T1 naphazoline hcl ophthalmic solution 0.1 % T1 neomycin-bacitracin zn-polymyx ophthalmic T1 ointment 5-400-10000 neomycin-polymyxin-dexameth ophthalmic T1 ointment 3.5-10000-0.1 neomycin-polymyxin-dexameth ophthalmic T1 suspension 3.5-10000-0.1

86 Drug Status Notes neomycin-polymyxin-gramicidin ophthalmic T1 solution 1.75-10000-.025 neomycin-polymyxin-hc ophthalmic suspension T1 3.5-10000-1 NEO-POLYCIN HC OPHTHALMIC T1 OINTMENT 1 % NUTRATEAR OPHTHALMIC SOLUTION T1 0.6 % ofloxacin ophthalmic solution 0.3 % T1 PHOSPHOLINE IODIDE OPHTHALMIC T1 SOLUTION RECONSTITUTED 0.125 % pilocarpine hcl ophthalmic solution 1 %, 2 % T1 polymyxin b-trimethoprim ophthalmic solution T1 10000-0.1 unit/ml-% PRED MILD OPHTHALMIC SUSPENSION T1 0.12 % prednisolone acetate ophthalmic suspension 1 % T1 prednisolone sodium phosphate ophthalmic T1 solution 1 % proparacaine hcl ophthalmic solution 0.5 % T1 PURE & GENTLE LUBRICANT T1 OPHTHALMIC SOLUTION 3 MG/ML ra sterile eye drops ophthalmic solution 0.03-0.5 T1 % redness relief max strength ophthalmic solution T1 0.03-0.5 % REDNESS RELIEF OPHTHALMIC T1 SOLUTION 0.012-0.25 % redness reliever eye drops ophthalmic solution T1 0.05 % REFRESH CELLUVISC OPHTHALMIC T1 GEL 1 % REFRESH OPTIVE ADVANCED PF T1 OPHTHALMIC SOLUTION 0.5-1-0.5 % REFRESH OPTIVE SENSITIVE T1 OPHTHALMIC SOLUTION 0.5-0.9 % RETAINE MGD OPHTHALMIC T1 EMULSION 0.5-0.5 % sm redness relief ophthalmic solution 0.012-0.2 % T1 sodium chloride (hypertonic) ophthalmic ointment T1 5 % sodium chloride (hypertonic) ophthalmic solution T1 5 % 87 Drug Status Notes SOOTHE OPHTHALMIC SOLUTION 0.6-0.6 T1 % STERILE LUBRICANT OPHTHALMIC T1 LIQUID 0.7 % sulfacetamide sodium ophthalmic ointment 10 % T1 sulfacetamide sodium ophthalmic solution 10 % T1 sulfacetamide-prednisolone ophthalmic solution T1 10-0.23 % SYSTANE OPHTHALMIC GEL 0.4-0.3 % T1 SYSTANE OVERNIGHT THERAPY T1 OPHTHALMIC GEL 0.3 % tgt lubricant eye drops ophthalmic solution 0.95 T1 % THERATEARS PF OPHTHALMIC T1 SOLUTION 0.25 % timolol maleate ophthalmic solution 0.25 %, 0.5 T1 % TIMOPTIC OCUDOSE OPHTHALMIC T1 SOLUTION 0.25 %, 0.5 % TOBRADEX OPHTHALMIC OINTMENT T1 0.3-0.1 % tobramycin ophthalmic solution 0.3 % T1 tobramycin-dexamethasone ophthalmic T1 QL (5 ML per 10 days) suspension 0.3-0.1 % TOBREX OPHTHALMIC OINTMENT 0.3 % T1 travoprost ophthalmic solution 0.004 % T1 ST; QL (5 ML per 30 days) trifluridine ophthalmic solution 1 % T1 tropicamide ophthalmic solution 0.5 %, 1 % T1 VASOCLEAR-A OPHTHALMIC T1 SOLUTION 0.02-0.25 % VISINE TEARS OPHTHALMIC SOLUTION T1 0.2-0.36-1 % *Otic Agents* acetic acid otic solution 2 % T1 acetic acid-aluminum acetate otic solution 2 % T1 antipyrine-benzocaine otic solution 5.4-1.4 % T1 ciprofloxacin hcl otic solution 0.2 % T1 ear drops otic solution 6.5 % T1 ear wax cleansing otic kit 6.5 % T1 hydrocortisone-acetic acid otic solution 1-2 % T1 neomycin-polymyxin-hc otic solution 1 % T1

88 Drug Status Notes neomycin-polymyxin-hc otic suspension 3.5- T1 10000-1 ofloxacin otic solution 0.3 % T1 pinnacaine otic otic solution 20 % T1 *Oxytocics* methylergonovine maleate oral tablet 0.2 mg T1 *Passive Immunizing And Treatment Agents* RHOGAM ULTRA-FILTERED PLUS INTRAMUSCULAR SOLUTION T1 GR-F PREFILLED SYRINGE 1500 UNIT SYNAGIS INTRAMUSCULAR SOLUTION T1 PA 100 MG/ML, 50 MG/0.5ML *Penicillins* amoxicillin oral capsule 250 mg, 500 mg T1 amoxicillin oral suspension reconstituted 125 T1 mg/5ml, 200 mg/5ml, 250 mg/5ml, 400 mg/5ml amoxicillin oral tablet 500 mg, 875 mg T1 amoxicillin oral tablet chewable 125 mg, 250 mg T1 amoxicillin-pot clavulanate oral suspension reconstituted 200-28.5 mg/5ml, 400-57 mg/5ml, T1 600-42.9 mg/5ml amoxicillin-pot clavulanate oral tablet 250-125 T1 QL (42 EA per 14 days) mg amoxicillin-pot clavulanate oral tablet 500-125 T1 QL (28 EA per 14 days) mg, 875-125 mg amoxicillin-pot clavulanate oral tablet chewable T1 AL (Max 11 Years) 200-28.5 mg, 400-57 mg ampicillin oral capsule 250 mg, 500 mg T1 ampicillin oral suspension reconstituted 125 T1 mg/5ml, 250 mg/5ml BICILLIN C-R 900/300 INTRAMUSCULAR T1 QL (4 ML per 28 days) SUSPENSION 900000-300000 UNIT/2ML BICILLIN C-R INTRAMUSCULAR T1 QL (4 ML per 28 days) SUSPENSION 1200000 UNIT/2ML dicloxacillin sodium oral capsule 250 mg, 500 mg T1 penicillin v potassium oral solution reconstituted T1 125 mg/5ml, 250 mg/5ml penicillin v potassium oral tablet 250 mg, 500 mg T1 *Pharmaceutical Adjuvants* benzyl alcohol liquid T1

89 Drug Status Notes cherry concentrate oral syrup T1 cherry oral syrup T1 FLAVOR BLEND ORAL SUSPENSION T1 flavor plus oral liquid T1 flavor sweet oral syrup T1 flavor sweet-sf oral liquid† T1 grape syrup oral syrup T1 ORA-BLEND ORAL SUSPENSION T1 ORA-BLEND SF ORAL SUSPENSION T1 ORAL MIX ORAL LIQUID T1 ORAL MIX SF ORAL LIQUID T1 oral suspend oral liquid T1 oral syrup oral liquid T1 oral syrup sf oral liquid T1 ORA-PLUS ORAL LIQUID T1 ORA-SWEET ORAL SYRUP T1 ORA-SWEET SF ORAL SYRUP T1 PCCA SWEET-SF ORAL SYRUP T1 PCCA SYRUP VEHICLE ORAL SYRUP T1 PCCA-PLUS ORAL SUSPENSION T1 polyethylene glycol 3350 powder T1 simple syrup oral syrup T1 SYRPALTA (RED) ORAL SYRUP T1 syrpalta oral syrup T1 SYRSPEND SF ORAL LIQUID T1 VERSAFREE ORAL SYRUP T1 VERSAPLUS ORAL SYRUP T1 *Progestins* medroxyprogesterone acetate oral tablet 10 mg, T1 GR-F; QL (30 EA per 30 days) 2.5 mg, 5 mg norethindrone acetate oral tablet 5 mg T1 GR-F; QL (60 EA per 30 days) *Psychotherapeutic And Neurological Agents - Misc.* acamprosate calcium oral tablet delayed release T1 333 mg apo-varenicline oral tablet 0.5 mg, 1 mg T1 QL (60 EA per 30 days) AVONEX INTRAMUSCULAR KIT 30 MCG T1 PA AVONEX PEN INTRAMUSCULAR AUTO- T1 PA INJECTOR KIT 30 MCG/0.5ML 90 Drug Status Notes AVONEX PREFILLED INTRAMUSCULAR T1 PA PREFILLED SYRINGE KIT 30 MCG/0.5ML BETASERON SUBCUTANEOUS KIT 0.3 T1 PA MG bupropion hcl er (smoking det) oral tablet T1 QL (180 EA per 365 days) extended release 12 hour 150 mg CHANTIX CONTINUING MONTH PAK T1 QL (60 EA per 30 days) ORAL TABLET 1 MG CHANTIX ORAL TABLET 0.5 MG, 1 MG T1 QL (60 EA per 30 days) CHANTIX STARTING MONTH PAK ORAL T1 QL (60 EA per 30 days) TABLET 0.5 MG X 11 & 1 MG X 42 dimethyl fumarate oral capsule delayed release T1 PA; QL (30 EA per 30 days) 120 mg, 240 mg disulfiram oral tablet 250 mg, 500 mg T1 donepezil hcl oral tablet 10 mg, 5 mg T1 EXTAVIA SUBCUTANEOUS KIT 0.3 MG T1 PA galantamine hydrobromide oral tablet 12 mg, 4 T1 mg, 8 mg glatiramer acetate subcutaneous solution T1 PA prefilled syringe 40 mg/ml GLATOPA SUBCUTANEOUS SOLUTION T1 PA PREFILLED SYRINGE 20 MG/ML MAYZENT ORAL TABLET 0.25 MG, 2 MG T1 PA memantine hcl oral tablet 10 mg, 5 mg T1 QL (60 EA per 30 days) memantine hcl oral tablet 28 x 5 mg & 21 x 10 mg T1 QL (49 EA per 365 days) nicotine mini mouth/throat lozenge 2 mg T1 QL (270 EA per 30 days) nicotine polacrilex mouth/throat gum 2 mg, 4 mg T1 QL (270 EA per 30 days) nicotine polacrilex mouth/throat lozenge 4 mg T1 QL (270 EA per 30 days) nicotine transdermal kit 21-14-7 mg/24hr T1 nicotine transdermal patch 24 hour 14 mg/24hr, T1 21 mg/24hr, 7 mg/24hr NICOTROL INHALATION INHALER 10 T1 QL (168 EA per 30 days) MG *Respiratory Agents - Misc.* PULMOZYME INHALATION SOLUTION 1 T1 PA MG/ML *Sulfonamides* sulfadiazine oral tablet 500 mg T1 *Tetracyclines* doxycycline hyclate oral capsule 100 mg, 50 mg T1 doxycycline hyclate oral tablet 100 mg, 20 mg T1 91 Drug Status Notes doxycycline monohydrate oral suspension T1 reconstituted 25 mg/5ml minocycline hcl oral capsule 100 mg, 50 mg, 75 T1 mg VIBRAMYCIN ORAL SYRUP 50 MG/5ML T1 *Thyroid Agents* ARMOUR THYROID ORAL TABLET 120 MG, 15 MG, 180 MG, 240 MG, 30 MG, 300 T1 MG, 60 MG, 90 MG levothyroxine sodium oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 T1 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg LEVOXYL ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 T1 MCG, 200 MCG, 25 MCG, 50 MCG, 75 MCG, 88 MCG liothyronine sodium oral tablet 25 mcg, 5 mcg, 50 T1 mcg methimazole oral tablet 10 mg, 5 mg T1 NATURE-THROID ORAL TABLET 113.75 MG, 130 MG, 146.25 MG, 16.25 MG, 162.5 T1 MG, 195 MG, 260 MG, 32.5 MG, 325 MG, 48.75 MG, 65 MG, 81.25 MG, 97.5 MG np thyroid oral tablet 120 mg, 15 mg, 30 mg, 60 T1 mg, 90 mg propylthiouracil oral tablet 50 mg T1 SYNTHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 T1 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG thyroid oral tablet 65 mg T1 UNITHROID ORAL TABLET 100 MCG, 112 MCG, 125 MCG, 137 MCG, 150 MCG, 175 T1 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG WESTHROID ORAL TABLET 130 MG, 195 T1 MG, 32.5 MG, 65 MG, 97.5 MG WP THYROID ORAL TABLET 113.75 MG, 130 MG, 16.25 MG, 32.5 MG, 48.75 MG, 65 T1 MG, 81.25 MG, 97.5 MG *Ulcer Drugs/Antispasmodics/Anticholinergics * cimetidine hcl oral solution 300 mg/5ml T1 AL (Max 12 Years) 92 Drug Status Notes cimetidine oral tablet 200 mg, 300 mg, 400 mg, T1 800 mg dicyclomine hcl oral capsule 10 mg T1 dicyclomine hcl oral solution 10 mg/5ml T1 dicyclomine hcl oral tablet 20 mg T1 famotidine intravenous solution 20 mg/2ml, 200 T1 mg/20ml, 40 mg/4ml famotidine oral suspension reconstituted 40 T1 AL (Max 12 Years) mg/5ml famotidine oral tablet 10 mg, 20 mg, 40 mg T1 famotidine premixed intravenous solution 20-0.9 T1 mg/50ml-% FIRST-LANSOPRAZOLE ORAL T1 QL (150 ML per 30 days) SUSPENSION 3 MG/ML FIRST-OMEPRAZOLE ORAL T1 QL (150 ML per 30 days) SUSPENSION 2 MG/ML glycopyrrolate oral tablet 1 mg, 2 mg T1 hyoscyamine sulfate er oral tablet extended T1 release 12 hour 0.375 mg hyoscyamine sulfate oral elixir 0.125 mg/5ml T1 hyoscyamine sulfate oral solution 0.125 mg/ml T1 hyoscyamine sulfate oral tablet 0.125 mg T1 hyoscyamine sulfate oral tablet dispersible 0.125 T1 mg hyoscyamine sulfate sublingual tablet sublingual T1 0.125 mg lansoprazole oral capsule delayed release 15 mg T1 QL (60 EA per 30 days) lansoprazole oral capsule delayed release 30 mg T1 QL (30 EA per 30 days) misoprostol oral tablet 100 mcg, 200 mcg T1 omeprazole oral capsule delayed release 10 mg, T1 QL (30 EA per 30 days) 40 mg omeprazole oral capsule delayed release 20 mg T1 QL (60 EA per 30 days) pantoprazole sodium oral tablet delayed release T1 QL (30 EA per 30 days) 20 mg pantoprazole sodium oral tablet delayed release T1 QL (60 EA per 30 days) 40 mg PEPCID AC MAXIMUM STRENGTH ORAL T1 TABLET CHEWABLE 20 MG phenobarbital-belladonna alk oral elixir 16.2 T1 mg/5ml propantheline bromide oral tablet 15 mg T1

93 Drug Status Notes ra omeprazole-sodium bicarb capsule 20-1100 T1 QL (60 EA per 30 days) mg oral 20-1100 mg sucralfate oral tablet 1 gm T1 *Urinary Antispasmodics* bethanechol chloride oral tablet 10 mg, 25 mg, 5 T1 mg, 50 mg oxybutynin chloride er oral tablet extended T1 release 24 hour 10 mg, 15 mg, 5 mg oxybutynin chloride oral syrup 5 mg/5ml T1 oxybutynin chloride oral tablet 5 mg T1 OXYTROL FOR WOMEN TRANSDERMAL T1 PATCH TWICE WEEKLY 3.9 MG/24HR OXYTROL TRANSDERMAL PATCH T1 TWICE WEEKLY 3.9 MG/24HR tolterodine tartrate er oral capsule extended T1 ST release 24 hour 2 mg, 4 mg tolterodine tartrate oral tablet 1 mg, 2 mg T1 ST TOVIAZ ORAL TABLET EXTENDED T1 ST RELEASE 24 HOUR 4 MG, 8 MG trospium chloride er oral capsule extended T1 ST release 24 hour 60 mg trospium chloride oral tablet 20 mg T1 ST VESICARE ORAL TABLET 10 MG, 5 MG T1 ST *Vaccines* AFLURIA INTRAMUSCULAR QL (0.5 ML per 365 days); AL T1 SUSPENSION (Min 5 Years) AFLURIA PRESERVATIVE FREE QL (0.5 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 5 Years) PREFILLED SYRINGE 0.5 ML AFLURIA QUADRIVALENT QL (0.5 ML per 365 days); AL T1 INTRAMUSCULAR SUSPENSION (Min 6 Months) AFLURIA QUADRIVALENT QL (0.25 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 6 Months and Max 35 PREFILLED SYRINGE 0.25 ML Months) AFLURIA QUADRIVALENT QL (0.5 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 6 Months) PREFILLED SYRINGE 0.5 ML AFLURIA QUADRIVALENT SUSPENSION QL (0.00001 ML per 365 days); PREFILLED SYRINGE 0.5 ML T1 AL (Min 5 Years) INTRAMUSCULAR 0.5 ML AFLURIA QUADRIVALENT SUSPENSION QL (0.5 ML per 365 days); AL PREFILLED SYRINGE 0.5 ML T1 (Min 5 Years) INTRAMUSCULAR 0.5 ML 94 Drug Status Notes FLUAD INTRAMUSCULAR SUSPENSION QL (0.5 ML per 365 days); AL T1 PREFILLED SYRINGE 0.5 ML (Min 65 Years) FLUAD QUADRIVALENT QL (0.5 ML per 365 days); AL INTRAMUSCULAR PREFILLED SYRINGE T1 (Min 65 Years) 0.5 ML FLUARIX QUADRIVALENT QL (0.5 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 6 Months) PREFILLED SYRINGE 0.5 ML FLUCELVAX INTRAMUSCULAR SUSPENSION PREFILLED SYRINGE 0.5 T1 QL (0.5 ML per 365 days) ML FLULAVAL QUADRIVALENT QL (0.5 ML per 365 days); AL T1 INTRAMUSCULAR SUSPENSION (Min 6 Months) FLULAVAL QUADRIVALENT QL (0.5 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 6 Months) PREFILLED SYRINGE 0.5 ML FLUVIRIN INTRAMUSCULAR QL (0.5 ML per 365 days); AL T1 SUSPENSION (Min 4 Years) FLUVIRIN INTRAMUSCULAR QL (0.5 ML per 365 days); AL SUSPENSION PREFILLED SYRINGE 0.5 T1 (Min 4 Years) ML FLUVIRIN PRESERVATIVE FREE QL (0.5 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 4 Years) PREFILLED SYRINGE 0.5 ML FLUZONE HIGH-DOSE INTRAMUSCULAR QL (0.5 ML per 365 days); AL SUSPENSION PREFILLED SYRINGE 0.5 T1 (Min 65 Years) ML FLUZONE HIGH-DOSE QUADRIVALENT QL (0.7 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 65 Years) PREFILLED SYRINGE 0.7 ML FLUZONE HIGH-DOSE SUSPENSION QL (0.5 ML per 365 days); AL PREFILLED SYRINGE 0.5 ML T1 (Min 65 Years) INTRAMUSCULAR 0.5 ML FLUZONE QUADRIVALENT QL (0.5 ML per 365 days); AL T1 INTRAMUSCULAR SUSPENSION , 0.5 ML (Min 6 Months) FLUZONE QUADRIVALENT QL (0.25 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 6 Months and Max 35 PREFILLED SYRINGE 0.25 ML Months) FLUZONE QUADRIVALENT QL (0.5 ML per 365 days); AL INTRAMUSCULAR SUSPENSION T1 (Min 6 Months) PREFILLED SYRINGE 0.5 ML SHINGRIX INTRAMUSCULAR QL (2 EA per 2 lifetimes); AL SUSPENSION RECONSTITUTED 50 T1 (Min 50 Years) MCG/0.5ML

95 Drug Status Notes ZOSTAVAX SUBCUTANEOUS SOLUTION T1 AL (Min 60 Years) RECONSTITUTED 19400 UNT/0.65ML *Vaginal And Related Products* CLEOCIN VAGINAL SUPPOSITORY 100 T1 GR-F MG clindamycin phosphate vaginal cream 2 % T1 GR-F clotrimazole 3 vaginal cream 2 % T1 GR-F clotrimazole-7 vaginal cream 1 % T1 GR-F estradiol vaginal cream 0.1 mg/gm T1 GR-F estradiol vaginal tablet 10 mcg T1 GYNAZOLE-1 VAGINAL CREAM 2 % T1 GR-F metronidazole vaginal gel 0.75 % T1 GR-F miconazole 3 combo pack vaginal kit 200 & 2 T1 GR-F mg-% (9gm) miconazole 3 vaginal suppository 200 mg T1 GR-F miconazole 7 vaginal cream 2 % T1 GR-F miconazole 7 vaginal suppository 100 mg T1 GR-F terconazole vaginal cream 0.4 %, 0.8 % T1 GR-F terconazole vaginal suppository 80 mg T1 GR-F *Vasopressors* epinephrine solution auto-injector 0.15 T1 QL (2 EA per 30 days) mg/0.15ml injection 0.15 mg/0.15ml epinephrine solution auto-injector 0.15 mg/0.3ml T1 QL (2 EA per 30 days) injection 0.15 mg/0.3ml epinephrine solution auto-injector 0.3 mg/0.3ml T1 QL (2 EA per 30 days) injection 0.3 mg/0.3ml midodrine hcl oral tablet 10 mg, 2.5 mg, 5 mg T1 QL (90 EA per 30 days) SYMJEPI SOLUTION PREFILLED SYRINGE 0.15 MG/0.3ML INJECTION 0.15 T1 QL (2 EA per 30 days) MG/0.3ML *Vitamins* ACEROLA C 500 ORAL WAFER 500 MG T1 ascocid-iso-ph oral powder effervescent T1 ascorbic acid injection solution 500 mg/ml T1 b1 natural oral tablet 250 mg T1 b-1 oral tablet 500 mg T1 B-2-400 ORAL CAPSULE 400 MG T1 b-6 oral tablet 500 mg T1 benfotiamine oral capsule 150 mg T1 biotin 5000 oral capsule 5 mg T1 96 Drug Status Notes biotin forte oral tablet 3 mg T1 biotin oral capsule 1 mg, 2500 mcg T1 biotin oral tablet 10 mg, 1000 mcg, 300 mcg, 5 T1 mg, 7500 mcg, 800 mcg B-NATAL MOUTH/THROAT LOZENGE 25 T1 MG B-NATAL MOUTH/THROAT LOZENGE T1 ON A HANDLE 25 MG BPROTECTED VITAMIN C ORAL LIQUID T1 500 MG/5ML buffered vitamin c oral capsule 1000 mg T1 calcium ascorbate oral tablet 500 mg T1 calcium pantothenate oral tablet 100 mg, 200 mg, T1 500 mg cvs biotin oral capsule 10 mg T1 cvs vitamin c oral tablet chewable 1000 mg T1 CYTO B2 ORAL POWDER 343 MG/GM T1 d 1000 oral tablet 25 mcg (1000 ut) T1 d 5000 oral tablet 125 mcg (5000 ut) T1 fruit c oral tablet chewable 100 mg T1 LEXINAL ORAL TABLET 2.5 MG T1 LIQUID C 500 ORAL LIQUID 500 MG/15ML T1 M2 POTASSIUM ORAL CAPSULE 60 MG T1 NEURO-K-250 T.D. ORAL CAPSULE 250 T1 MG niacin er oral capsule extended release 250 mg, T1 500 mg niacin er oral tablet extended release 1000 mg, T1 250 mg, 500 mg, 750 mg niacin oral tablet 100 mg, 250 mg, 50 mg, 500 mg T1 niacinamide oral tablet 100 mg, 500 mg T1 niacinamide oral tablet extended release 500 mg T1 paba oral tablet 100 mg T1 panto-250 oral capsule 250 mg T1 pantothenic acid oral tablet 500 mg T1 phytonadione oral tablet 5 mg T1 POTABA ORAL CAPSULE 500 MG T1 PROTEXIN ORAL SYRUP 500 MG/15ML T1 ra vitamin c oral tablet chewable 300 mg T1 riboflavin oral capsule 100 mg, 50 mg T1

97 Drug Status Notes riboflavin oral tablet 400 mg T1 sodium ascorbate granules T1 thiamine oral capsule 50 mg T1 vita-c oral crystals T1 vitamin b1 oral tablet 100 mg T1 vitamin b-1 oral tablet 100 mg, 250 mg, 50 mg T1 vitamin b-2 oral tablet 100 mg, 25 mg, 50 mg T1 vitamin b-6 er oral tablet extended release 200 T1 mg vitamin b-6 oral tablet 100 mg, 25 mg, 250 mg, T1 50 mg vitamin b6 oral tablet 200 mg T1 vitamin c (calcium ascorbate) oral solution T1 reconstituted vitamin c drops mouth/throat lozenge 60 mg T1 vitamin c er oral capsule extended release 500 mg T1 vitamin c er oral tablet extended release 1500 mg, T1 500 mg vitamin c gummie oral tablet chewable 120 mg T1 vitamin c oral capsule 500 mg T1 vitamin c oral syrup 500 mg/5ml T1 vitamin c oral tablet 100 mg, 1000 mg, 250 mg, T1 500 mg vitamin c oral tablet chewable 250 mg, 500 mg T1 vitamin c-rose hips er oral tablet extended release T1 1000 mg vitamin d (cholecalciferol) oral capsule 10 mcg T1 AL (Min 65 Years) (400 unit) vitamin d (ergocalciferol) oral capsule 1.25 mg T1 QL (4 EA per 28 days) (50000 ut) QL (60 EA per 30 days); AL (Min vitamin d3 oral tablet 10 mcg (400 unit) T1 65 Years) vitamin e oral capsule 400 unit T1 vitamin k (phytonadione) oral tablet 100 mcg T1

98 Index 1st tier unifine pentips...... 62 AFLURIA PRESERVATIVE amoxicillin-pot clavulanate...... 89 1st tier unifine pentips plus...... 62 FREE...... 94 amphetamine-dextroamphet er..... 1 abacavir sulfate...... 26 AFLURIA QUADRIVALENT 94 amphetamine- abacavir sulfate-lamivudine...... 26 AGORAL MAXIMUM dextroamphetamine...... 1 abacavir-lamivudine-zidovudine 26 STRENGTH...... 60 ampicillin...... 89 acamprosate calcium...... 90 ALA-HIST PE...... 35 anagrelide hcl...... 57 acarbose...... 13 albuterol sulfate...... 9 anastrozole...... 23 ACCU-CHEK TENDER 1 alclometasone dipropionate...... 47 ANBESOL...... 79 INFUSION...... 62 alendronate sodium...... 54 ANECREAM...... 47 acebutolol hcl...... 28 aler-dryl...... 18 anefrin spray...... 83 ACEPHEN...... 4 alevazol...... 47 anesthesia extension tubing...... 62 ACEROLA C 500...... 96 alfuzosin hcl er...... 56 ANORO ELLIPTA...... 9 ACETADRYL...... 59 ALKA-SELTZER antacid...... 6 ACETA-GESIC...... 34 HEARTBURN...... 6 antacid & antigas...... 6 acetaminophen...... 4 ALKA-SELTZER PLS antacid extra strength...... 6 acetaminophen er...... 4 ALLERGY & CGH...... 35 antacid multi-symptom...... 6 acetaminophen-codeine...... 5 ALKA-SELTZER PLUS antioxidant formula sg...... 80 acetaminophen-codeine #2...... 5 COLD & COUGH...... 35 antipyrine-benzocaine...... 88 acetaminophen-codeine #3...... 5 ALKA-SELTZER PLUS anti-stick insulin syringe...... 62 acetaminophen-codeine #4...... 5 COLD & FLU...... 35 apap...... 4 acetazolamide...... 53 ALKA-SELTZER PLUS ap-hist dm...... 35 acetazolamide er...... 53 DAY/NIGHT...... 35 apo-varenicline...... 90 acetic acid...... 88 ALKA-SELTZER PLUS APRISO...... 56 acetic acid-aluminum acetate..... 88 NIGHT COLD...... 35 APTIVUS...... 26 acetone...... 31 ALKA-SELTZER PLUS AQUADEKS...... 80 acetylcysteine...... 34 SINUS...... 35 ARANELLE...... 32 acidophilus/citrus pectin...... 16 all day pain relf sinus/cold d...... 35 ARGYLE EXTENSION acidophilus/pectin...... 16 aller-chlor...... 18 TUBE 20"...... 63 acne medication 10...... 47 allergy multi-symptom day/nght. 35 ARGYLE STERILE WATER.79 acne medication 5...... 47 allergy spray 24 hour...... 83 aripiprazole...... 24 ACTIPHYTE OF aller-time...... 35 armodafinil...... 1 LEMONGRASS...... 31 allopurinol...... 57 ARMOUR THYROID...... 92 acyclovir...... 26 ALMACONE...... 6 artificial tears...... 84 adapalene...... 47 alogliptin benzoate...... 13 ascocid-iso-ph...... 96 ADULT ACNOMEL...... 47 alogliptin-metformin hcl...... 14 ascorbic acid...... 96 adult aspirin low strength...... 4 alogliptin-pioglitazone...... 14 ASCRIPTIN...... 4 adult gummy...... 80 alprazolam...... 8 ASPERCREME LIDOCAINE 47 ADVAIR DISKUS...... 9 amantadine hcl...... 24 ASPERCREME advanced lubricant...... 84 ambi 12.5cpd/100gfn/30pse...... 35 W/LIDOCAINE...... 47 ADVIL ALLERGY & ambi 12.5cpd/1dcpm/30pse...... 35 aspirin...... 4 CONGESTION...... 34 amiloride hcl...... 53 aspirin adult low strength...... 4 ADVIL ALLERGY SINUS...... 34 amiloride-hydrochlorothiazide... 53 aspirin low dose...... 4 ADVIL COLD & SINUS amiodarone hcl...... 8 aspirtab maximum strength...... 4 LIQUI-GELS...... 35 amitriptyline hcl...... 12 ASSURE DOSE CONTROL... 63 ADVOCATE INSULIN PEN amlodipine besy-benazepril hcl.. 20 ASSURE ID INSULIN NEEDLES...... 62 amlodipine besylate...... 29 SAFETY SYR...... 63 ADVOCATE INSULIN amlodipine besylate-valsartan....20 ATABEX...... 80 SYRINGE...... 62 amlodipine-olmesartan...... 20 ATABEX EC...... 80 AEROSPAN...... 9 ammonium lactate...... 31, 47 atazanavir sulfate...... 26 AFLURIA...... 94 amoxapine...... 12 atenolol...... 29 amoxicillin...... 89 atenolol-chlorthalidone...... 20 99 atomoxetine hcl...... 1 BD INSULIN SYRINGE BD SAF-T-INTIMA 22G X atorvastatin calcium...... 19 MICROFINE...... 63 0.75"...... 65 atovaquone...... 22 BD INSULIN SYRINGE U/F.. 63 BD SAF-T-INTIMA atropine sulfate...... 84 BD INSULIN SYRINGE U-40.63 22GX3/4"...... 65 ATROVENT HFA...... 9 BD INSULIN SYRINGE BD SAF-T-INTIMA 24G X aurora pen needles...... 63 ULTRAFINE...... 64 0.75"...... 65 aurora unifine pentips...... 63 BD INTEGRA INSULIN BD SAF-T-INTIMA AUTOJECT 2...... 63 SYRINGE...... 64 24GX3/4"...... 65 AVONEX...... 90 BD INTEGRA SYRINGE...... 64 BD SYRINGE/NEEDLE...... 65 AVONEX PEN...... 90 BD L-CATH 16G/5FR...... 64 BD SYRINGE/NEEDLE AVONEX PREFILLED...... 91 BD L-CATH 16G/5FRX60CM 64 SLIP TIP...... 65 azathioprine...... 79 BD L-CATH 18G/3.5FR...... 64 BD VACUTAINER SET...... 65 azelastine hcl...... 84 BD L-CATH benazepril hcl...... 20 azithromycin...... 62 18G/3.5FRX60CM...... 64 benazepril-hydrochlorothiazide..20 b-1...... 96 BD L-CATH 20G/2.6FR...... 64 benfotiamine...... 96 b1 natural...... 96 BD L-CATH benzonatate...... 35 B-2-400...... 96 20G/2.6FRX60CM...... 64 BENZ-O-STHETIC...... 79 b-6...... 96 BD L-CATH 20G/3FR...... 64 benzoyl peroxide...... 47 bacitracin...... 47, 85 BD L-CATH 20G/3FRX60CM 64 benzoyl peroxide cleanser...... 47 bacitracin zinc...... 47 BD L-CATH benzoyl peroxide wash...... 47 bacitracin-neomycin-polymyxin..47 28G/1.2FRX25CM...... 64 benzoyl peroxide-erythromycin...47 bacitracin-polymyxin b...... 85 BD L-CATH MIDLINE benztropine mesylate...... 24 bacitra-neomycin-polymyxin-hc. 85 18G/3.5FRX20...... 64 benzyl alcohol...... 89 baclofen...... 83 BD L-CATH MIDLINE benzyl benzoate...... 31 balsalazide disodium...... 56 20G/3FRX20CM...... 64 BESIVANCE...... 85 BASIS OVERNIGHT...... 47 BD LUER-LOK SYRINGE..... 64 betamethasone dipropionate.47, 48 b-complex balanced...... 80 BD NEXIVA 18GX1.25"...... 64 betamethasone dipropionate b-complex/vitamin c...... 80 BD NEXIVA 18GX1.75"...... 64 aug...... 47 BD ANGIOCATH BD NEXIVA 20GX1"...... 64 betamethasone valerate...... 48 AUTOGUARD...... 63 BD NEXIVA 20GX1.25"...... 64 BETASERON...... 91 BD AUTOSHIELD...... 63 BD NEXIVA 20GX1.75"...... 64 betaxolol hcl...... 85 BD AUTOSHIELD DUO...... 63 BD NEXIVA 22GX1"...... 64 bethanechol chloride...... 94 BD ECLIPSE SYRINGE...... 63 BD NEXIVA 24GX0.56"...... 64 bicalutamide...... 23 BD FIRST MIDCATH BD NEXIVA 24GX0.75"...... 64 BICARSIM...... 56 18G/4FRX20CM...... 63 BD PEN NEEDLE MINI U/F.. 64 BICARSIM FORTE...... 56 BD FIRST MIDCATH BD PEN NEEDLE NANO BICILLIN C-R...... 89 20G/3FRX20CM...... 63 U/F...... 64 BICILLIN C-R 900/300...... 89 BD FIRST PICC BD PEN NEEDLE BIKTARVY...... 26 16G/5FRX65CM...... 63 ORIGINAL U/F...... 64 bimatoprost...... 85 BD FIRST PICC BD PEN NEEDLE SHORT biobron sf...... 35 18G/4FRX65CM...... 63 U/F...... 64 biodesp dm...... 35 BD FIRST PICC BD SAFETYGLIDE biogtuss...... 35 20G/3FRX65CM...... 63 INSULIN SYRINGE...... 64 bionatuss dxp...... 35 BD FIRST PICC BD SAFETY-LOK INSULIN bionel...... 35 22G/2.8FRX50CM...... 63 SYRINGE...... 64 bionel pediatric...... 35 BD FIRST PICC BD SAFETY-LOK SET...... 64 biospec dmx...... 35 26G/1.9FRX50CM...... 63 BD SAFETY-LOK biotin...... 97 BD INSULIN SYR VACUTAINER SET...... 65 biotin 5000...... 96 ULTRAFINE II...... 63 BD SAF-T E-Z SET...... 65 biotin forte...... 97 BD INSULIN SYRINGE...... 63 BD SAF-T-INTIMA 18G X 1" 65 biovol...... 80 BD INSULIN SYRINGE BD SAF-T-INTIMA 20GX1".. 65 bisacodyl...... 60 HALF-UNIT...... 63 bisacodyl ec...... 60

100 bismuth...... 16 calcium 500/d...... 75 carteolol hcl...... 85 bisoprolol fumarate...... 29 calcium 500+d...... 75 CARTIA XT...... 29 bisoprolol-hydrochlorothiazide.. 20 calcium 500+d high potency...... 75 carvedilol...... 29 BLEPHAMIDE S.O.P...... 85 calcium 600/vitamin d...... 75 CASTIVA WARMING...... 48 BLINK TEARS...... 85 calcium 600+d...... 75 CCP CAFFEINE FREE...... 36 B-NATAL...... 97 calcium 600+d3...... 75 cefaclor...... 30 bp cleansing...... 48 calcium acetate (phos binder).....56 cefadroxil...... 30 bp cleansing wash...... 48 calcium antacid ultra...... 6 cefdinir...... 30 bpm-dm-phen...... 35 calcium ascorbate...... 97 cefpodoxime proxetil...... 30, 31 BPROTECTED VITAMIN C..97 calcium carbonate...... 75 cefprozil...... 31 BRAINSTRONG calcium carbonate antacid...... 6 CEFTIN...... 31 PRENATAL...... 80 calcium carbonate-vitamin d...... 75 ceftriaxone sodium...... 31 BRASIVOL...... 48 calcium citrate...... 75 cefuroxime axetil...... 31 BREO ELLIPTA...... 9 calcium citrate + d...... 75 celecoxib...... 2 BRILINTA...... 57 calcium citrate + d3...... 75 CELLCEPT...... 79 brimonidine tartrate...... 85 calcium citrate malate-vit d...... 75 CENTRUM SPECIALIST bromocriptine mesylate...... 24 calcium citrate+d3 petites...... 76 PRENATAL...... 80 bronchial asthma relief...... 35 calcium citrate-vitamin d...... 76 cephalexin...... 31 BRONCOTRON PED...... 35 calcium citrate-vitamin d3...... 76 CERTUSS-D...... 36 BRONCOTRON PED calcium magnesium 750...... 76 cetirizine hcl...... 18 DROPS...... 35 calcium pantothenate...... 97 cetirizine-pseudoephedrine er.....36 BRONCOTRON-S...... 36 calcium plus vitamin d...... 76 CHANTIX...... 91 BRONKAID...... 36 calcium/vitamin d3 gummies...... 76 CHANTIX CONTINUING bronkids...... 36 calcium-carb 600 + d...... 76 MONTH PAK...... 91 brotapp dm...... 36 calcium-magnesium...... 76 CHANTIX STARTING budesonide...... 9 calcium-vitamin d...... 76 MONTH PAK...... 91 budesonide-formoterol fumarate.. 9 calcium-vitamin d3...... 76 chelated magnesium...... 76 buffasal...... 4 cal-mag aspartate...... 76 CHEMET...... 17 buffered aspirin...... 4 CAL-MAG CHELA-MAX...... 76 cheratussin ac...... 36 buffered vitamin c...... 97 calmag thins...... 76 cherry...... 90 bumetanide...... 53 CAL-QUICK...... 76 cherry concentrate...... 90 bupropion hcl...... 13 camphor spirit...... 31 chest congestion daytime...... 36 bupropion hcl er (smoking det)...91 capcof...... 36 chest congestion relief pe...... 36 bupropion hcl er (sr)...... 13 capecitabine...... 23 chest congestion/pain & sinus.... 36 bupropion hcl er (xl)...... 13 capmist dm...... 36 child chewable vitamins/iron...... 80 buspirone hcl...... 8 capron dm...... 36 childrens cough...... 36 butalbital-acetaminophen...... 4 capsaicin...... 48 childrens cough/runny nose...... 36 butalbital-apap-caff-cod...... 5 captopril...... 20 childrens gummies...... 80 butalbital-apap-caffeine...... 4 captopril-hydrochlorothiazide....20 childrens multivitamin...... 81 butalbital-asa-caff-codeine...... 5 CAPZASIN...... 48 childrens plus cold...... 36 butalbital-aspirin-caffeine...... 4 carbamazepine...... 11 childrens plus cold & allergy..... 36 BYSTOLIC...... 29 carbamazepine er...... 11 childrens plus flu...... 36 cal/mag...... 75 CARBAPHEN CH...... 36 childrens silfedrine...... 83 CALAGESIC...... 48 CARBAPHEN PED CH...... 36 CHILDRENS SOOTHE...... 6 CALCET CREAMY BITES....75 carbidopa...... 24 CHLO TUSS...... 36 calcitonin (salmon)...... 54 carbidopa-levodopa...... 24 chlo tuss ex...... 36 cal-citrate plus vitamin d...... 75 carbidopa-levodopa er...... 24 chlophed...... 36 calcitriol...... 54 CAREFINE PEN NEEDLES...65 chlordiazepoxide hcl...... 8 calcium...... 76 careone insulin syringe...... 65 chlorhexidine gluconate...... 31, 79 calcium + d3...... 75 careone unifine pentips...... 65 chloroform...... 31 calcium 1000 + d...... 75 careone unifine pentips plus...... 65 chloroquine phosphate...... 22 calcium 500 + d...... 75 CAROSPIR...... 53 chlorothiazide...... 53

101 chlorpheniramine maleate...... 18 cold head congestion daytime.....37 cvs antacid supreme...... 6 chlorpheniramine maleate er...... 18 cold head congestion nighttime.. 37 cvs biotin...... 97 chlorpropamide...... 14 cold multi-symptom day/night.....37 cvs calcium...... 76 chlorthalidone...... 53 cold multi-symptom warm night. 37 cvs cortisone cooling relief...... 48 chlorzoxazone...... 83 cold relief plus...... 37 cvs cough & sore throat child.....37 cholestyramine...... 19 cold/flu relief...... 37 cvs gas relief drops ex st...... 56 cholestyramine light...... 19 cold/flu relief day/night...... 37 cvs heartburn relief ex st...... 7 choline & mag trisalicylate...... 4 cold/flu relief nighttime...... 37 cvs hydrocortisone acetate...... 48 choline-mag trisalicylate...... 4 colestipol hcl...... 19 cvs lubricant drops...... 85 ciclopirox...... 48 COMFORT EZ INSULIN cvs mini enema kids...... 60 cilostazol...... 57 SYRINGE...... 65 cvs nasal allergy spray...... 84 CILOXAN...... 85 COMFORT EZ PEN cvs natural fiber supplement...... 60 cimetidine...... 93 NEEDLES...... 65 cvs non-drying sinus pe...... 37 cimetidine hcl...... 92 COMPLERA...... 26 cvs oyster shell calcium+vit d.....76 CIPRO...... 55 COMPLETE cvs prenatal gummy...... 81 ciprofloxacin hcl...... 56, 85, 88 FORMULATION cvs targeted acne spot...... 48 citalopram hydrobromide...... 13 PEDIATRIC...... 81 cvs vitamin c...... 97 citric acid-sodium citrate...... 56 complete natal dha...... 81 cyanocobalamin...... 57 CITROCARBONATE...... 6 complete prenatal/dha...... 81 cyclobenzaprine hcl...... 83 clarithromycin...... 62 complete protein/vitamin shake.. 53 CYCLOMYDRIL...... 85 CLARITIN CHILDRENS...... 18 complete sinus relief...... 37 cyclopentolate hcl...... 85 CLEAN & CLEAR ACNE CONEX COLD/ALLERGY.... 37 cyclophosphamide...... 23 CONTROL...... 48 CONTAC COLD+FLU MAX cyclosporine...... 79 clemastine fumarate...... 18 ST...... 37 cyclosporine modified...... 79 CLEOCIN...... 96 cool mist humidifier...... 65 cyproheptadine hcl...... 18 clickfine pen needles...... 65 CORICIDIN HBP CYTO B2...... 97 clindamycin hcl...... 22 CONGESTION/COUGH...... 37 cytra k crystals...... 57 clindamycin palmitate hcl...... 22 CORICIDIN HBP cytra-2...... 57 clindamycin phosphate...... 48, 96 DAY/NIGHT COLD...... 37 CYTRA-3...... 57 CLINICAL NUTRIENTS CORICIDIN NIGHTTIME cytra-k...... 57 PRENATAL...... 81 COLD-COUGH...... 37 d 1000...... 97 clobetasol propionate...... 48 CORNWALL METAL d 5000...... 97 clonazepam...... 11 PIPETTING...... 65 daily multiple vitamins/min...... 81 clonidine hcl...... 20 CORRECTOL HERBAL DAILY PAK MAXIMUM clopidogrel bisulfate...... 57 TEA...... 60 MULTIVITAMIN...... 81 clorazepate dipotassium...... 8 cortisone acetate...... 34 daily vitamin plus...... 81 clotrimazole...... 48, 79 CORTISPORIN...... 48 daily-vitamin...... 81 clotrimazole 3...... 96 CORTIZONE-10/ALOE...... 48 DALLERGY...... 37, 38 clotrimazole-7...... 96 CORVITA...... 81 dapsone...... 22 clotrimazole-betamethasone...... 48 cottonseed oil...... 31 day time pe cold/flu relief...... 38 clozapine...... 25 cough & cold...... 37 daytime cold & cough childrens. 38 codeine sulfate...... 5 cough & sore throat nighttime....37 DAYTIME COLD codituss dm...... 36 cough daytime/nighttime...... 37 MEDICINE...... 38 colchicine...... 57 CREON...... 53 DELSYM CGH/CLD colchicine-probenecid...... 57 CRIXIVAN...... 26 NIGHTTIME CHILD...... 38 cold & cough childrens...... 36 cromolyn sodium...... 83, 85 DELTUSS DMX...... 38 cold & cough day/night child..... 36 CRYOSERV...... 31 DELTUSS DP...... 38 cold & cough daytime...... 36 CULTURELLE DIGESTIVE DENOREX DUAL FORCE..... 48 cold & flu nighttime/daytime...... 37 HEALTH...... 16, 17 DENTS TOOTHACHE...... 80 cold & flu relief nighttime d...... 37 CURITY ALCOHOL PREPS. 65 denture adhesive...... 65 cold & flu severe daytime...... 37 cvs allergy childrens...... 18 DESCOVY...... 26 cold control pe cold/flu med...... 37 cvs antacid & anti-gas...... 6 DESGEN DM...... 38

102 DESGEN PEDIATRIC...... 38 diphenhydramine hcl...... 18, 19 EASY TOUCH PEN desmopressin ace spray refrig.... 54 diphenhydramine hcl (sleep)...... 59 NEEDLES...... 66 desmopressin acetate...... 54 diphenhydramine-apap (sleep)... 59 EASY TOUCH SAFETY desmopressin acetate spray...... 54 diphenoxylate-atropine...... 17 SYRINGE...... 66 desogestrel-ethinyl estradiol...... 32 dipyridamole...... 57 econazole nitrate...... 49 desonide...... 48 disopyramide phosphate...... 8 ed bron gp...... 38 despec dm...... 38 disulfiram...... 91 ED CHLORPED...... 19 despec-dm...... 38 DIURIL...... 54 ED CHLORPED D...... 38 DEWEES CARMINATIVE...... 7 divalproex sodium...... 11 ed-a-hist dm...... 38 dexamethasone...... 34 divalproex sodium er...... 11 EDURANT...... 26 DEXAMETHASONE docosanol...... 49 efavirenz...... 26 INTENSOL...... 34 docusate calcium...... 60 efavirenz-emtricitab-tenofovir.... 26 dexamethasone sodium docusate sodium...... 60 efavirenz-lamivudine-tenofovir...26 phosphate...... 85 DOCUSOL MINI...... 60 effaclar duo...... 49 dexchlorpheniramine maleate.....18 DOCUSOL PLUS MINI- ELDERTONIC...... 81 dexmethylphenidate hcl...... 1 ENEMA...... 60 ELIGARD...... 23 dexmethylphenidate hcl er...... 1 DOLOGEN...... 38 ELIQUIS...... 11 dextroamphetamine sulfate...... 1 dometuss-da/children...... 38 elite ca/mg...... 76 dextroamphetamine sulfate er...... 1 dometuss-dmx...... 38 ELITE IRON...... 57 dextromethorphan-guaifenesin... 38 donepezil hcl...... 91 elite-thin insulin syringe...... 66 DIABETIC TUSSIN COLD & DORIBAX...... 22 ELLA...... 32 FLU...... 38 dorzolamide hcl...... 85 emtricitabine...... 26 DIABETIC TUSSIN NIGHT dorzolamide hcl-timolol mal...... 85 emtricitabine-tenofovir df...... 26 COLD/FLU...... 38 doxazosin mesylate...... 20 EMTRIVA...... 26 DIALYVITE SUPREME D..... 81 doxepin hcl...... 13 enalapril maleate...... 20 DIASTAT ACUDIAL...... 11 doxycycline hyclate...... 91 enalapril-hydrochlorothiazide....20 diazepam...... 8, 11 doxycycline monohydrate...... 92 ENBREL...... 3 diclofenac potassium...... 2 doxylamine-phenylephrine...... 38 ENBREL SURECLICK...... 3 diclofenac sodium...... 2, 48, 85 dr manzanilla pe...... 38 ENDACOF-DM...... 38 diclofenac sodium er...... 2 DRAMAMINE...... 17 ENDACON...... 38 dicloxacillin sodium...... 89 dronabinol...... 17 enoxaparin sodium...... 11 dicyclomine hcl...... 93 drospirenone-ethinyl estradiol....32 entacapone...... 24 didanosine...... 26 drug mart unifine pentips...... 65 ENTEX LQ...... 38 DIFFERIN...... 48 drug mart unifine pentips plus....65 ENTEX T...... 38 DIFIL-G FORTE...... 9 DULERA...... 9 entre-cough...... 39 diflorasone diacetate...... 49 duloxetine hcl...... 13 ENTRESTO...... 30 diflunisal...... 4 DUPIXENT...... 49 epinastine hcl...... 85 digoxin...... 30 DURAVENT PE...... 38 epinephrine...... 96 DILANTIN...... 11 ear drops...... 88 EPITOL...... 11 diltiazem cd...... 29 ear wax cleansing...... 88 EPIVIR HBV...... 26 diltiazem hcl...... 30 EASIVENT...... 65 EPOGEN...... 57 diltiazem hcl er...... 29 EASIVENT MASK LARGE....65 eq allergy/sinus headache...... 39 diltiazem hcl er beads...... 29 EASIVENT MASK MEDIUM 66 eq childrens cold...... 39 diltiazem hcl er coated beads...... 29 EASIVENT MASK SMALL....66 eq cold plus...... 39 dilt-xr...... 30 easy comfort insulin syringe...... 66 eq cold relief complete...... 39 dimenhydrinate...... 17 easy comfort pen needles...... 66 eq cold/cough plus...... 39 DIMETAPP LONG ACT EASY TOUCH FLURINGE....66 eq daytime cold/flu relief...... 39 COUGH/COLD...... 38 EASY TOUCH INSULIN eq flu & severe cold & cough..... 39 dimethyl fumarate...... 91 SAFETY SYR...... 66 eq flu relief...... 39 dimethyl sulfoxide...... 31 EASY TOUCH INSULIN eq flu/severe cold/congestion...... 39 diocto...... 60 SYRINGE...... 66 eq lubricating eye drops...... 85 diphenhist...... 18 eq nasal allergy...... 84

103 eq night time cold & cough...... 39 fentanyl...... 5 fluocinolone acetonide scalp...... 49 eq nite time cold/flu relief...... 39 ferretts...... 58 fluocinonide...... 49 eq nitetime cold/flu ms relief...... 39 ferretts chewable iron...... 58 fluocinonide-e...... 49 eq non-drying sinus...... 39 ferretts ips...... 58 fluorometholone...... 86 eq sinus congestion & pain...... 39 FERRIMIN 150...... 58 fluorouracil...... 49 eq triacting cold/allergy...... 39 ferrous aspartate...... 58 fluoxetine hcl...... 13 eql calcium/vitamin d...... 76 ferrous fumarate...... 58 fluphenazine hcl...... 25 eql childrens multivitamins...... 81 ferrous gluconate...... 58 flurazepam hcl...... 59 eql congestion relief...... 39 ferrous sulfate...... 58 flurbiprofen...... 3 eql gummies childrens...... 81 ferrous sulfate er...... 58 flurbiprofen sodium...... 86 eql insulin syringe...... 66 fexofenadine hcl...... 19 flutamide...... 23 eql vitamin d-3 high potency...... 76 fexofenadine hcl childrens...... 19 fluticasone propionate...... 49, 84 EQUALACTIN...... 60 FIASP...... 14 fluticasone-salmeterol...... 9, 10 ERLEADA...... 23 FIASP FLEXTOUCH...... 14 FLUVIRIN...... 95 erythromycin...... 49, 85 FIASP PENFILL...... 14 FLUVIRIN PRESERVATIVE escitalopram oxalate...... 13 fiber laxative...... 60 FREE...... 95 estazolam...... 59 fiber therapy...... 60 fluvoxamine maleate...... 13 estradiol...... 55, 96 FIFTY50 PEN NEEDLES...... 66 FLUZONE HIGH-DOSE...... 95 estradiol-norethindrone acet...... 55 FIFTY50 SUPERIOR FLUZONE HIGH-DOSE estropipate...... 55 COMFORT SYR...... 66 QUADRIVALENT...... 95 eszopiclone...... 59 finasteride...... 57 FLUZONE ethambutol hcl...... 23 first aid antibiotic...... 49 QUADRIVALENT...... 95 ether...... 31 FIRST-LANSOPRAZOLE...... 93 FML...... 86 ethosuximide...... 12 FIRST-OMEPRAZOLE...... 93 FOLGARD OS...... 81 ethyl alcohol...... 31 FIRST-VANCOMYCIN 25...... 22 folic acid...... 58 ethyl alcohol (rubbing)...... 31 FIRST-VANCOMYCIN 50...... 22 FOLITAB 500...... 58 ethyl chloride...... 49 FIRVANQ...... 22 FORADIL AEROLIZER...... 10 etravirine...... 26 FLAREX...... 86 formoterol fumarate...... 10 EUCERIN...... 49 FLAVOR BLEND...... 90 fosamprenavir calcium...... 27 eugenol...... 31 flavor plus...... 90 fosinopril sodium...... 20 EVAC-U-GEN...... 60 flavor sweet...... 90 fosinopril sodium-hctz...... 20 EXEL COMFORT POINT flavor sweet-sf...... 90 fosphenytoin sodium...... 12 INSULIN SYR...... 66 flecainide acetate...... 8 freds pharmacy unifine pentip+..66 EXODERM...... 49 FLEET BISACODYL...... 61 freds pharmacy unifine pentips...66 EXTAVIA...... 91 FLEET NATURALS FREESTYLE CONTROL eye allergy relief...... 85 CLEANSING ENEMA...... 6 SOLUTION...... 67 eye drops...... 85 FLINTSTONES TODDLER....81 FREESTYLE PRECISION eye drops allergy relief...... 85 FLOVENT DISKUS...... 9 INS SYR...... 67 eye lubricant...... 85 FLOVENT HFA...... 9 fruit c...... 97 ezetimibe...... 19 flu & sore throat...... 39 FUNGOID TINCTURE...... 49 EZFE 200...... 58 flu/severe cold & cough day...... 39 furosemide...... 54 E-Z-GAS II...... 7 FLUAD...... 95 gabapentin...... 12 famciclovir...... 26 FLUAD QUADRIVALENT.....95 galantamine hydrobromide...... 91 famotidine...... 93 FLUARIX QUADRIVALENT 95 GAS-X EXTRA STRENGTH..56 famotidine premixed...... 93 FLUCELVAX...... 95 gauze sponge...... 67 FASENRA...... 9 fluconazole...... 18 GAVILYTE-C...... 61 felodipine er...... 30 fludrocortisone acetate...... 34 GAVILYTE-G...... 61 FEMIRON...... 58 fluid administration set...... 66 GAVISCON...... 7 FENESIN DM IR...... 39 FLULAVAL GEL-TIN...... 80 fenofibrate...... 19 QUADRIVALENT...... 95 gemfibrozil...... 19 fenofibrate micronized...... 19 fluocinolone acetonide...... 49 GENCONTUSS...... 39 fenoprofen calcium...... 3 fluocinolone acetonide body...... 49 GENGRAF...... 79

104 GENOTROPIN...... 54 granulderm...... 49 HUMIRA PEN-PS/UV/ADOL GENOTROPIN MINIQUICK.54 grape syrup...... 90 HS START...... 3 GENTAK...... 86 griseofulvin microsize...... 18 hydralazine hcl...... 21 gentamicin sulfate...... 49, 86 griseofulvin ultramicrosize...... 18 hydrochlorothiazide...... 54 GENTEAL MILD...... 86 G-TRON PEDIATRIC HYDROCIL...... 61 GENVOYA...... 27 DROPS...... 39 hydrocod polst-cpm polst er...... 40 geri-mucil...... 61 guaiacol...... 32 hydrocodone-acetaminophen...... 5 glatiramer acetate...... 91 guaifenesin...... 39, 40 hydrocodone-homatropine...... 40 GLATOPA...... 91 guaifenesin dm...... 39 hydrocortisone...... 6, 34, 50 GLEOSTINE...... 23 guaifenesin er...... 39 hydrocortisone max st...... 50 glimepiride...... 14 guaifenesin-dm...... 40 hydrocortisone valerate...... 50 glipizide...... 14 guanfacine hcl...... 20 hydrocortisone-acetic acid...... 88 glipizide xl...... 14 guanfacine hcl er...... 1 hydrocortisone-aloe...... 50 glipizide-metformin hcl...... 14 GYNAZOLE-1...... 96 hydromorphone hcl...... 5 global ease inject pen needles.... 67 G-ZYNCOF...... 40 hydroxychloroquine sulfate...... 22 global inject ease insulin syr...... 67 H 468L TUBING...... 67 hydroxyprogesterone caproate... 32 glucagon emergency...... 14 halobetasol propionate...... 49 hydroxyurea...... 23 GLUCOCARD haloperidol...... 25 hydroxyzine hcl...... 8 EXPRESSION CONTROL...... 67 haloperidol decanoate...... 25 hydroxyzine pamoate...... 8 GLUCOCARD HC DERMAPAX...... 50 hyoscyamine sulfate...... 93 EXPRESSION TEST...... 52 healthwise mini pen needles...... 67 hyoscyamine sulfate er...... 93 GLUCOCARD VITAL TEST. 52 healthwise pen needles...... 67 HYPOTEARS...... 86 GLUCOPRO INSULIN healthwise short pen needles...... 67 ibandronate sodium...... 54 SYRINGE...... 67 healthwise unifine pentips...... 67 ibuprofen...... 3 glyburide...... 14 healthy accents unifine pentip.....67 ibu-profen cold/sinus...... 40 glyburide micronized...... 14 HEALTHY MAMA BE ibuprofen pm...... 59 glyburide-metformin...... 14 WELL ROUNDED...... 81 IFEREX 150...... 58 glycerin...... 31, 49 heartburn antacid ex st...... 7 imatinib mesylate...... 23 glycerin (adult)...... 61 h-e-b incontrol pen needles...... 67 imipramine hcl...... 13 glycerin (infants & children)...... 61 heparin sodium (porcine)...... 11 INCRUSE ELLIPTA...... 10 glycerin adult...... 61 heparin sodium (porcine) pf...... 11 indapamide...... 54 glycerine...... 31 HERBAL EXPEC...... 40 INDOCIN...... 3 glycerol formal...... 31 HEXALEN...... 23 indomethacin...... 3 glycine soya extract...... 31 high potency iron...... 58 infants pain relief...... 5 glycine soya protein...... 32 HISTEX-DM...... 40 infusion set...... 68 glycopyrrolate...... 93 hist-pse...... 40 infusion set 23" comfort...... 68 gnp 24 hour nasal allergy...... 84 hm iron...... 58 inject-ease...... 68 gnp alcohol denatured...... 32 HM ULTICARE INSULIN INJECT-EASE gnp calcium 500 +d3...... 76 SYRINGE...... 67 AUTOMATIC INJECTOR..... 68 gnp clickfine pen needles...... 67 HOMATROPAIRE...... 86 INSUFLON...... 68 gnp foaming antacid...... 7 HONEY BEARS W/IRON- insulin syringe...... 68 gnp insulin syringe...... 67 ZINC...... 81 insulin syringe/needle...... 68 gnp peppermint spirit...... 32 HUBER INFUSION SET...... 67 insupen pen needles...... 68 gnp sodium silicate...... 32 HUMATROPEN FOR 12MG..68 INSUPEN SENSITIVE...... 68 gnp ultra com insulin syringe..... 67 HUMATROPEN FOR 24MG..68 INSUPEN ULTRAFIN...... 68 GOLYTELY...... 61 HUMATROPEN FOR 6MG....68 INSYTE AUTOGUARD GONIOTAIRE...... 86 HUMIRA...... 3 14GX1.75"...... 68 goodsense nasal allergy spray....84 HUMIRA PEDIATRIC INSYTE AUTOGUARD G-P-TUSS DXP...... 39 CROHNS START...... 3 18GX1.16"...... 68 GRANDPAS THYLOX HUMIRA PEN...... 3 INSYTE AUTOGUARD SOAP...... 49 HUMIRA PEN-CD/UC/HS 20GX1"...... 68 granisetron hcl...... 17 STARTER...... 3

105 INSYTE AUTOGUARD kinray insulin syringe...... 68 LEXINAL...... 97 20GX1.16"...... 68 KIONEX...... 79 LEXIVA...... 27 INSYTE AUTOGUARD KLOR-CON M15...... 76 lexuss 210...... 40 22GX1"...... 68 KLOXXADO...... 17 lice killing maximum strength.....50 INSYTE AUTOGUARD kmart valu insulin syringe 29g... 68 lice solution...... 50 24GX3/4"...... 68 kmart valu insulin syringe 30g... 68 lice treatment...... 50 INTELENCE...... 27 KONSYL...... 61 LICEMD...... 50 intense cough reliever...... 40 konsyl daily fiber...... 61 LICIDE TREATMENT...... 50 INTRON A...... 23 KONSYL-D...... 61 lidocaine...... 50 INVIRASE...... 27 K-PHOS...... 76 lidocaine hcl...... 50, 80 INVOKAMET...... 14 K-PHOS NO 2...... 57 lidocaine hcl (pf)...... 62 INVOKAMET XR...... 14 kpn prenatal...... 81 lidocaine viscous...... 80 INVOKANA...... 14 kroger insulin syringe...... 68 lidocaine-prilocaine...... 50 ipratropium bromide...... 10, 84 kroger pen needles...... 68 lindane...... 50 irbesartan...... 21 L606 TUBING...... 68 linezolid...... 22 irbesartan-hydrochlorothiazide..21 L609 TUBING...... 68 liothyronine sodium...... 92 iron...... 58 labetalol hcl...... 29 LIQUID C 500...... 97 iron (ferrous gluconate)...... 58 LAC-HYDRIN FIVE...... 50 liquid calcium with d3...... 76 iron chews pediatric...... 58 lactic acid...... 50 LIQUIMAT...... 50 iron complex...... 58 lactic acid e...... 50 liquituss gg...... 40 IRON UP...... 58 lactulose...... 61 lisinopril...... 21 ISENTRESS...... 27 lactulose encephalopathy...... 56 lisinopril-hydrochlorothiazide....21 isoniazid...... 23 lamivudine...... 27 LITETOUCH INSULIN isopropyl alcohol...... 32 lamivudine-zidovudine...... 27 SYRINGE...... 69 isopropyl alcohol (rubbing)...... 32 lamotrigine...... 12 LITETOUCH PEN isopropyl alcohol wipes...... 50 lamotrigine er...... 12 NEEDLES...... 69 isopropyl palmitate...... 32 lansoprazole...... 93 lithium carbonate...... 25 ISOPTO CARBACHOL...... 86 LANTUS...... 15 lithium carbonate er...... 25 ISOPTO HOMATROPINE..... 86 LANTUS SOLOSTAR...... 14 LITTLE REMEDIES FOR ISOPTO TEARS...... 86 latanoprost...... 86 COLDS...... 40 isosorbide dinitrate...... 7 laxative pills...... 61 LITTLE TEETHERS PAIN isosorbide dinitrate er...... 7 lc-4 lidocaine...... 50 RELIEF...... 80 isosorbide mononitrate...... 7 leader insulin syringe...... 69 LMX 4...... 50 isosorbide mononitrate er...... 7 LEADER UNIFINE LO LOESTRIN FE...... 33 isradipine...... 30 PENTIPS...... 69 LODRANE D...... 40 itraconazole...... 18 LEADER UNIFINE LOHIST-D...... 40 ivermectin...... 7 PENTIPS PLUS...... 69 longs insulin syringe...... 69 JANTOVEN...... 11 leflunomide...... 3 loperamide hcl...... 17 JANUMET...... 14 letrozole...... 23 lopinavir-ritonavir...... 27 JANUMET XR...... 14 leucovorin calcium...... 23 loratadine...... 19 JANUVIA...... 14 LEUKERAN...... 23 loratadine allergy relief...... 19 JARDIANCE...... 14 LEVEMIR...... 15 loratadine childrens...... 19 JINTELI...... 55 LEVEMIR FLEXTOUCH...... 15 loratadine-d 12hr...... 40 JULUCA...... 27 levetiracetam...... 12 loratadine-d 24hr...... 40 KANGAROO BURETTE levobunolol hcl...... 86 lorazepam...... 8 SET...... 68 levocetirizine dihydrochloride.... 19 LORTAB...... 5 KELNOR 1/35...... 32 levofloxacin...... 56 LORTUSS DM...... 40 ketoconazole...... 18, 50 levonorgest-eth estrad 91-day.... 32 LORTUSS LQ...... 40 ketoprofen...... 3 levonorgestrel...... 32 losartan potassium...... 21 ketorolac tromethamine...... 3, 86 levonorgestrel-ethinyl estrad...... 33 losartan potassium-hctz...... 21 KETOSTIX...... 53 levothyroxine sodium...... 92 LOTRIMIN AF...... 50 ketotifen fumarate...... 86 LEVOXYL...... 92 lovastatin...... 19

106 LOW-OGESTREL...... 33 medroxyprogesterone acetate miconazole 7...... 96 loxapine succinate...... 25 ...... 33, 90 miconazole nitrate...... 51 LTXF PRIM CNV PIN MEDSAVER SYRINGE...... 69 miconazorb af...... 51 MICRODRIP...... 69 mefloquine hcl...... 22 MICROGESTIN 1.5/30...... 33 LTXF PRIM IV SET/CNVT MEGA MULTIVITAMIN...... 81 MICROGESTIN FE 1.5/30...... 33 PIN...... 69 megestrol acetate...... 24 midodrine hcl...... 96 LTXF SECONDARY/CNV meijer pen needles...... 69 migraine relief...... 5 PIN/32INC...... 69 meloxicam...... 3 minocycline hcl...... 92 lubricant eye drops...... 86 memantine hcl...... 91 minoxidil...... 21 LUFYLLIN...... 10 m-end dmx...... 40 mirtazapine...... 13 LUPRON DEPOT (1- M-END PE...... 40 misoprostol...... 93 MONTH)...... 23 MENEST...... 55 modafinil...... 2 LUPRON DEPOT (3- meperidine hcl...... 5 moexipril hcl...... 21 MONTH)...... 23 mercaptopurine...... 24 mometasone furoate...... 51 LUPRON DEPOT (4- mesalamine...... 56 MONOJECT INSULIN MONTH)...... 24 METAMUCIL...... 61 SYRINGE...... 69 LUPRON DEPOT-PED (1- METAMUCIL MONOJECT LIFESHIELD MONTH)...... 54 MULTIHEALTH FIBER...... 61 SYRINGE...... 69 m2 magnesium...... 76 METAMUCIL SMOOTH MONOJECT MAGELLAN M2 POTASSIUM...... 97 TEXTURE...... 61 SYRINGE...... 69 MAG64...... 77 metaproterenol sulfate...... 10 MONOJECT ULTRA mag-al...... 7 metformin hcl...... 15 COMFORT SYRINGE...... 70 MAGELLAN INSULIN metformin hcl er...... 15 montelukast sodium...... 10 SAFETY SYR...... 69 methadone hcl...... 5 MOORE MONO INSULIN mag-g...... 77 methanol...... 32 SYRINGE...... 70 MAGINEX...... 77 methazolamide...... 54 morphine sulfate...... 5 MAGINEX DS...... 77 methenamine hippurate...... 22 morphine sulfate (concentrate).....5 magnesium...... 77 methenamine mandelate...... 22 morphine sulfate er...... 5 magnesium aspartate...... 77 methimazole...... 92 moxifloxacin hcl...... 56, 86 magnesium carbonate...... 77 methocarbamol...... 83 ms insulin syringe...... 70 magnesium chloride...... 77 methotrexate...... 24 MUCINEX CHILD MS DAY- magnesium citrate...... 61, 77 methotrexate sodium...... 24 NIGHT CLD...... 40 magnesium gluconate...... 77 methotrexate sodium (pf)...... 24 MUCINEX COUGH FOR magnesium lactate...... 77 methyclothiazide...... 54 KIDS...... 40 magnesium oxide...... 7, 77 methyl alcohol...... 32 MUCINEX FAST-MAX magnesium oxide -mg methyldopa...... 21 CONGEST COUGH...... 41 supplement...... 77 methylergonovine maleate...... 89 MUCINEX FOR KIDS...... 41 magnesium sulfate...... 77 methylphenidate hcl...... 2 MUCINEX SINUS-MAX magnesium sulfate in d5w...... 77 methylphenidate hcl er...... 2 DAY/NIGHT...... 41 MAGONATE...... 77 methylphenidate hcl er (cd)...... 1 mucus d...... 41 malathion...... 50 methylphenidate hcl er (la)...... 2 mucus relief cold flu throat...... 41 MAOX...... 7 methylprednisolone...... 34 mucus relief cold/sinus max st.... 41 MAR-COF BP...... 40 metipranolol...... 86 mucus relief d...... 41 MATULANE...... 24 metoclopramide hcl...... 56 mucus relief severe congst/cgh... 41 MAVYRET...... 27 metolazone...... 54 mucus-dm...... 41 maxi-tuss pe...... 40 metoprolol succinate er...... 29 mucus-dm max...... 41 MAYZENT...... 91 metoprolol tartrate...... 29 MULTAQ...... 8 meclizine hcl...... 17 metoprolol-hydrochlorothiazide. 21 multi-delyn...... 81 medic insulin syringe...... 69 metronidazole...... 22, 50, 51, 96 multi-delyn/iron...... 81 medicine shoppe pen needles...... 69 MI-ACID...... 7 multi-purpose solution...... 86 medi-first hydrocortisone...... 50 miconazole 3...... 96 multivitamins...... 81 miconazole 3 combo pack...... 96 mupirocin...... 51

107 MURO 128...... 86 NERIA 29G INFUSION SET NORDITROPIN FLEXPRO mycophenolate mofetil...... 79 6MM...... 70 ...... 54, 55 MYKIDZ IRON...... 81 NERIA 29G INFUSION SET NOREL AD...... 41 MYKIDZ IRON 10...... 58 8MM...... 70 norethin ace-eth estrad-fe...... 33 MYLERAN...... 24 NERIA MULTI 27G norethindrone...... 33 MYNATAL...... 81 2X10MM...... 70 norethindrone acetate...... 90 mynatal plus...... 81 NERIA MULTI 27G norethindrone acet-ethinyl est.... 33 mynate 90 plus...... 81 3X10MM...... 70 norethindrone-eth estradiol...... 55 nabumetone...... 3 NERIA MULTI 27G norgestimate-eth estradiol...... 33 nadolol...... 29 4X12MM...... 70 NORPACE CR...... 8 naloxone hcl...... 17 NERIA SOFT 25G nortriptyline hcl...... 13 naltrexone hcl...... 17 INFUSION 13MM...... 70 nortuss-ex...... 41 NANOVM T/F...... 82 NERIA SOFT 25G NORVIR...... 27 naphazoline hcl...... 86 INFUSION 17MM...... 70 NOVAFERRUM 50...... 59 naproxen...... 3 NEURO-K-250 T.D...... 97 NOVAFERRUM NAPROXEN COMFORT NEUTROGENA CLEAR PEDIATRIC DROPS...... 59 PAC...... 3 PORE...... 51 NOVOFINE...... 70 naproxen dr...... 3 nevirapine...... 27 NOVOFINE AUTOCOVER....70 naproxen sodium...... 3, 4 nevirapine er...... 27 NOVOFINE PLUS...... 70 naratriptan hcl...... 74 NEXAFED...... 84 NOVOLIN 70/30...... 15 NARCAN...... 17 niacin...... 97 NOVOLIN 70/30 FLEXPEN... 15 NASACORT ALLERGY niacin er...... 97 NOVOLIN 70/30 FLEXPEN 24HR...... 84 niacinamide...... 97 RELION...... 15 nasal allergy 24 hour...... 84 NIACOR...... 19 NOVOLIN 70/30 RELION...... 15 nasal decongestant...... 84 nicardipine hcl...... 30 NOVOLIN N...... 15 nasal mist...... 41 nicotine...... 91 NOVOLIN N FLEXPEN...... 15 NASOPEN...... 41 nicotine mini...... 91 NOVOLIN N RELION...... 15 NASOPEN PE...... 41 nicotine polacrilex...... 91 NOVOLIN R...... 15 NATALVIT...... 82 NICOTROL...... 91 NOVOLIN R FLEXPEN...... 15 nateglinide...... 15 nifedipine...... 30 NOVOLIN R RELION...... 15 natural fiber laxative...... 61 nifedipine er...... 30 NOVOLOG...... 16 natural psyllium seed...... 61 nifedipine er osmotic release...... 30 NOVOLOG 70/30 FLEXPEN natural senna laxative...... 61 nighttime cough...... 41 RELION...... 15 NATURE-THROID...... 92 nighttime pain plus sleep...... 41 NOVOLOG FLEXPEN...... 15 NECON 0.5/35 (28)...... 33 nimodipine...... 30 NOVOLOG FLEXPEN NECON 1/35 (28)...... 33 nite-time cold/flu relief...... 41 RELION...... 15 NECON 1/50 (28)...... 33 NITRO-BID...... 7 NOVOLOG MIX 70/30...... 16 NECON 10/11 (28)...... 33 nitrofurantoin...... 22 NOVOLOG MIX 70/30 NECON 7/7/7...... 33 nitrofurantoin macrocrystal...... 22 FLEXPEN...... 16 neomycin sulfate...... 2 nitrofurantoin monohyd macro...22 NOVOLOG MIX 70/30 neomycin-bacitracin zn- nitroglycerin...... 8 RELION...... 16 polymyx...... 86 nitroglycerin er...... 8 NOVOLOG RELION...... 16 neomycin-polymyxin-dexameth...86 NIVANEX DMX...... 41 NOVOPEN ECHO...... 70 neomycin-polymyxin-gramicidin 87 NOBLE MYSTIQUE EMU- NOVOTWIST...... 70 neomycin-polymyxin-hc.. 87, 88, 89 LAC...... 51 np thyroid...... 92 NEO-POLYCIN HC...... 87 nohist-lq...... 41 NUOX...... 51 NEOSPORIN ESSENTIALS non-pseudo cold relief...... 41 NUTRATEAR...... 87 TRIAL PK...... 51 NORDIPEN 5 INJECTION nystatin...... 18, 51, 80 NEOTUSS PLUS...... 41 DEVICE...... 70 nystatin-triamcinolone...... 51 NEOTUSS-D...... 41 NORDIPEN DELIVERY OBSTETRIX DHA...... 82 NERIA 29G INFUSION SET SYSTEM...... 70 OBSTETRIX EC...... 82 10MM...... 70 OC8...... 51

108 O-CAL PRENATAL...... 82 OXYTROL...... 94 PERRY PRENATAL...... 82 OCELLA...... 33 OXYTROL FOR WOMEN..... 94 PERTZYE...... 53 ODEFSEY...... 27 OYSCO 500+D...... 77 phenazopyridine hcl...... 57 ofloxacin...... 56, 87, 89 oyster shell calcium plus d...... 78 phenelzine sulfate...... 13 OGESTREL...... 33 oyster shell calcium/d...... 78 phenobarbital...... 60 olanzapine...... 25 OZEMPIC (0.25 OR 0.5 phenobarbital-belladonna alk.... 93 olmesartan medoxomil...... 21 MG/DOSE)...... 16 phenylephrine-chlorphen-dm...... 42 olmesartan medoxomil-hctz...... 21 OZEMPIC (1 MG/DOSE)...... 16 phenylephrine-dm-gg...... 42 omeprazole...... 93 pa prenatal formula...... 82 phenylhistine dh...... 42 OMNIFLEX DIAPHRAGM....70 paba...... 97 phenytoin...... 12 OMNITROPE PEN 10 INJ PANATUSS PED...... 41 phenytoin sodium...... 12 DEVICE...... 70 PANATUSS PED DROPS...... 41 phenytoin sodium extended...... 12 OMNITROPE PEN 5 INJ PANCREAZE...... 53 PHOSPHA 250 NEUTRAL..... 78 DEVICE...... 70 pancrelipase (lip-prot-amyl)...... 53 PHOSPHOLINE IODIDE...... 87 ondansetron...... 17 PANOXYL-8 CREAMY phosphorus supplement...... 78 ondansetron hcl...... 17 WASH...... 51 phytonadione...... 97 ONE-A-DAY WOMENS panto-250...... 97 pilocarpine hcl...... 80, 87 PRENATAL...... 82 pantoprazole sodium...... 93 pindolol...... 29 ONETOUCH DELICA pantothenic acid...... 97 pine tar...... 32 LANCETS 30G...... 70 paroxetine hcl...... 13 pink bismuth...... 17 ONETOUCH DELICA parva-cal...... 78 pink bismuth maximum strength. 17 LANCETS 33G...... 70 pc unifine pentips...... 70 pinnacaine otic...... 89 ONETOUCH ULTRA PCCA SWEET-SF...... 90 PIN-X...... 7 CONTROL...... 70 PCCA SYRUP VEHICLE...... 90 pioglitazone hcl...... 16 ONETOUCH VERIO...... 53, 70 PCCA-PLUS...... 90 pioglitazone hcl-metformin hcl... 16 ORA-BLEND...... 90 PECGEN DMX...... 42 piroxicam...... 4 ORA-BLEND SF...... 90 PEDIACARE CHILD plastic adapter...... 70 ORACIT...... 57 ALLERGY/COLD...... 42 podofilox...... 51 ORA-FILM...... 80 PEDIA-LAX...... 61 poly vitamin...... 82 oral analgesic max st...... 80 PEDIALYTE...... 78 polyethylene glycol 3350...... 61, 90 oral anesthetic...... 80 pediatric cough/cold...... 42 poly-hist dm...... 42 ORAL MIX...... 90 peg 3350...... 61 poly-hist pd...... 42 ORAL MIX SF...... 90 peg 3350/electrolytes...... 61 poly-iron 150 forte...... 59 oral suspend...... 90 PEGINTRON...... 27 polymyxin b-trimethoprim...... 87 oral syrup...... 90 PEG-INTRON...... 28 polysorbate 20...... 32 oral syrup sf...... 90 PEG-INTRON REDIPEN...... 27 polysorbate 40...... 32 ORAMAGIC PLUS...... 80 PEG-INTRON REDIPEN polysorbate 60...... 32 ORA-PLUS...... 90 PAK 4...... 27 polysorbate 80...... 32 ORA-SWEET...... 90 pen needles...... 70 poly-tussin ac...... 42 ORA-SWEET SF...... 90 pen needles 1/2"...... 70 POLY-VENT DM...... 42 ORAZINC...... 77 pen needles 3/16"...... 70 POLY-VENT IR...... 42 oseltamivir phosphate...... 27 pen needles 5/16"...... 70 polyvitamin...... 82 OSTEO-PORETICAL...... 77 penicillin v potassium...... 89 polyvitamin/iron...... 82 OSTIGEN...... 77 pentoxifylline er...... 57 pot bicarb-pot chloride...... 78 oxaprozin...... 4 PEPCID AC MAXIMUM POTABA...... 97 oxazepam...... 8 STRENGTH...... 93 potassium bicarbonate...... 78 oxcarbazepine...... 12 peppermint spirit...... 32 potassium chloride...... 78 oxybutynin chloride...... 94 PERFECT IRON...... 59 potassium chloride crys er...... 78 oxybutynin chloride er...... 94 perindopril erbumine...... 21 potassium chloride er...... 78 oxycodone hcl...... 5, 6 PERIOMED...... 80 potassium citrate-citric acid...... 57 oxycodone-acetaminophen...... 6 permethrin...... 51 povidone-iodine...... 25 oxycodone-aspirin...... 6 perphenazine...... 25 PR NATAL 400...... 82

109 PR NATAL 430...... 82 prochlorperazine...... 25 quinapril hcl...... 21 PRALUENT...... 19 prochlorperazine maleate...... 25 quinapril-hydrochlorothiazide....21 pramipexole dihydrochloride...... 24 PRO-CLEAR AC...... 42 quinidine gluconate er...... 9 PRAMOSONE...... 51 PROCRIT...... 59 quinidine sulfate...... 9 prasugrel hcl...... 57 PRODIGY INSULIN quinine sulfate...... 22 pravastatin sodium...... 19 SYRINGE...... 71 QVAR...... 10 prazosin hcl...... 21 PROFE...... 59 QVAR REDIHALER...... 10 PRECISION SUREDOSE profe forte...... 82 ra acne maximum...... 51 PLUS SYR...... 71 PROFERRIN ES...... 59 ra acne treatment...... 51 PRECISION SURE-DOSE promethazine hcl...... 19 ra allergy multi-symptom...... 43 SYRINGE...... 71 promethazine vc plain...... 42 ra allergy multi-symptom night.. 43 PRECISION XTRA promethazine vc/codeine...... 42 ra allergy relief childrens...... 19 KETONE...... 53 promethazine-codeine...... 42 ra baby care oral pain relief...... 80 PRED MILD...... 87 promethazine-dm...... 42 ra calcium hi-cal/vitamin d...... 78 prednicarbate...... 51 PRONTO...... 51 ra calcium-boron...... 78 prednisolone...... 34 propafenone hcl...... 8 ra childrens cold & allergy...... 43 prednisolone acetate...... 87 propantheline bromide...... 93 ra cold & flu...... 43 prednisolone sodium phosphate proparacaine hcl...... 87 ra cold/cough sinus relief pe...... 43 ...... 34, 87 propranolol hcl...... 29 ra col-rite...... 61 prednisone...... 34 propranolol hcl er...... 29 ra ethyl alcohol...... 32 preferred plus insulin syringe.....71 propranolol-hctz...... 21 ra first aid anti-itch spray...... 51 preferred plus unifine pentips.....71 propylthiouracil...... 92 ra flu maximum strength...... 43 pregabalin...... 12 PRO-RED AC...... 42 ra glycerin child...... 61 PREMARIN...... 55 PROTEXIN...... 97 ra insulin syringe...... 71 PREMPHASE...... 55 pseudoeph-bromphen-dm...... 42 ra laxative...... 62 PREMPRO...... 55 pseudoephedrine hcl...... 84 ra laxative extra strength...... 62 PRENATA...... 82 pseudoephedrine hcl er...... 84 ra lice bedding...... 51 prenatabs fa...... 82 pseudoephedrine-guaifenesin er.42 ra lice egg remover...... 52 prenatal...... 82 PULMOZYME...... 91 ra lice solution...... 52 prenatal 19...... 82 PURE & GENTLE ra nasal allergy...... 84 prenatal complete...... 82 LUBRICANT...... 87 ra omeprazole-sodium bicarb.....94 prenatal formula...... 82 purefe ob plus...... 82 ra one daily...... 83 prenatal formula a-free...... 82 px extra short pen needles...... 71 ra pen needles...... 71 prenatal multi +dha...... 82 px insulin syringe...... 71 ra pink bismuth...... 17 PRENATAL px mini pen needles...... 71 ra probiotic digestive care...... 17 MULTIVITAMIN + DHA...... 82 px pen needle...... 71 ra severe cold/night cold&flu..... 43 prenatal plus...... 82 pyrazinamide...... 23 ra severe cold/sinus relief pe...... 43 prenatal plus iron...... 82 pyrethins-piperonyl butoxide...... 51 ra sinus congst/pain day/night....43 prenatal vitamins...... 82 pyrilamine-phenylephrine...... 42 ra sleep aid...... 60 prenatal/omega-3/fa/iron...... 82 qc childrens vitamins/extra c...... 82 ra sleep aid (diphenhydramine)..60 prenatal+dha...... 82 qc cold relief...... 42 ra sleep-aid nighttime...... 60 PRENATAL-U...... 82 qc cold relief plus...... 42 ra sterile eye drops...... 87 pres gen pediatric...... 42 qc flu relief therapy night...... 42 ra suphedrine day/night combo.. 43 PRETZ...... 32 qc medifin cp...... 42 ra suphedrine pe...... 43 PREZISTA...... 28 qc natural vegetable...... 61 ra tussin nighttime cough dm...... 43 primaquine phosphate...... 22 qc pen needles...... 71 ra vitamin c...... 97 primidone...... 12 qc unifine pentips...... 71 ra wart remover...... 52 PRIMSOL...... 22 q-pap...... 5 raloxifene hcl...... 55 PRO:12 MOUSSE AL12...... 51 q-pap infants...... 5 ramipril...... 21 probenecid...... 57 Q-TAPP...... 42 ranolazine er...... 8 probiotic-prebiotic...... 17 quetiapine fumarate...... 25 REDNESS RELIEF...... 87 pro-chlo...... 42 quetiapine fumarate er...... 25 redness relief max strength...... 87

110 redness reliever eye drops...... 87 ROBITUSSIN CHILD silver sulfadiazine...... 52 reeses pinworm medicine...... 7 COUGH/COLD LA...... 43 simethicone...... 56 REFENESEN CHEST ROBITUSSIN DAY/NIGHT simple syrup...... 90 CONG/PAIN RLF...... 43 VALUE PAK...... 43 simvastatin...... 20 refenesen plus...... 43 ROBITUSSIN PEAK COLD SINADRIN PE COMPLETE REFRESH CELLUVISC...... 87 MULTI-SYM...... 43 SINUS REL...... 44 REFRESH OPTIVE ROBITUSSIN PK COLD sinus daytime/nighttime...... 44 ADVANCED PF...... 87 DAY/NGHT DM...... 43 sinus maximum strength...... 44 REFRESH OPTIVE ROBITUSSIN PK COLD slow iron...... 59 SENSITIVE...... 87 DAY/NGHT MS...... 43 slow release iron...... 59 relcof c...... 43 ropinirole hcl...... 24 sm camphor spirit...... 32 RELENZA DISKHALER...... 28 rosuvastatin calcium...... 20 sm cough/runny nose childrens...44 RELION INSULIN ru-hist d...... 43 sm ibuprofren cold childrens...... 44 SYRINGE...... 71 RYBELSUS...... 16 sm insulin syringe...... 72 RELI-ON INSULIN rymed...... 43 sm pain reliever sinus pe...... 44 SYRINGE...... 71 SAFE TUSSIN PM...... 43 sm redness relief...... 87 RELION MINI PEN SAFELET IV CATHETER..... 71 sm slow release iron...... 59 NEEDLES...... 71 SAFESNAP INSULIN sm tussin cf...... 44 RELION PEN NEEDLES...... 71 SYRINGE...... 71 sodium ascorbate...... 98 RELION SHORT PEN saline nasal spray...... 84 sodium bicarbonate...... 7, 32 NEEDLES...... 71 salsalate...... 5 sodium chloride...... 44, 57, 78 RENAGEL...... 56 SANTYL...... 52 sodium chloride (hypertonic)...... 87 RENAL...... 83 sb daytime sinus...... 43 sodium chloride flush...... 78 REPATHA...... 20 sb insulin syringe...... 72 sodium fluoride...... 78 REPATHA PUSHTRONEX sb natural fiber laxative...... 62 sodium polystyrene sulfonate...... 79 SYSTEM...... 20 sb nighttime sinus multi-sympt....44 sodium silicate...... 32 REPATHA SURECLICK...... 20 sb severe cold congestion...... 44 sofosbuvir-velpatasvir...... 28 RESCON DM...... 43 scalp vein set...... 72 SOLUBLE FIBER RESCRIPTOR...... 28 schnucks insulin syringe...... 72 THERAPY...... 62 resorcinol-sulfur...... 52 SCHOOLTIME SHAMPOO...52 solution transfer device...... 72 RESPAIRE-30...... 43 SCOOBY-DOO ONE A DAY..83 sonahist dm...... 44 RETACRIT...... 59 SCOT-TUSSIN DM...... 44 SOOTHE...... 88 RETAINE MGD...... 87 SCOT-TUSSIN SENIOR...... 44 sotalol hcl...... 29 RHINOCORT ALLERGY...... 84 sebex...... 52 sotalol hcl (af)...... 29 RHOGAM ULTRA- selegiline hcl...... 24 SPATONE PUR-ABSORB FILTERED PLUS...... 89 selenium sulfide...... 52 IRON...... 59 RIBASPHERE...... 28 SELZENTRY...... 28 spironolactone...... 54 ribavirin...... 28 senna...... 62 spironolactone-hctz...... 54 riboflavin...... 97, 98 senna laxative...... 62 stahist ad...... 44 RID ESSENTIAL LICE senna leaves...... 62 stavudine...... 28 ELIMINATION...... 52 senna-docusate sodium...... 62 STEP 2...... 52 rifampin...... 23 SENSIPAR...... 55 STERILE LUBRICANT...... 88 RIFATER...... 23 SEREVENT DISKUS...... 10 sterile water for irrigation...... 79 riluzole...... 84 sertraline hcl...... 13 stress formula/iron...... 83 rimantadine hcl...... 28 sevelamer hcl...... 56 stress formula/zinc...... 83 risedronate sodium...... 55 sf 5000 plus...... 80 STRIBILD...... 28 risperidone...... 25 SFROWASA...... 56 STRIVERDI RESPIMAT...... 10 ritonavir...... 28 SHINGRIX...... 95 STUART ONE...... 83 rizatriptan benzoate...... 75 SHOPKO UNIFINE sucralfate...... 94 ROBITUSSIN CHILD PENTIPS...... 72 SUDAFED PE DAY & COUGH/COLD CF...... 43 sildenafil citrate...... 30 NIGHT...... 44 silphen cough...... 19

111 SUDOGEST terbinafine hcl...... 18, 52 tranexamic acid...... 59 SINUS/ALLERGY...... 44 terbutaline sulfate...... 10 tranylcypromine sulfate...... 13 sulfacetamide sodium...... 88 terconazole...... 96 travoprost...... 88 sulfacetamide sodium (acne)...... 52 terpin hydrate...... 44 trazodone hcl...... 13 sulfacetamide sodium-sulfur...... 52 testosterone cypionate...... 6 TRECATOR...... 23 sulfacetamide-prednisolone...... 88 testosterone enanthate...... 6 TRESIBA...... 16 sulfadiazine...... 91 tg 10peh/380gfn...... 44 TRESIBA FLEXTOUCH...... 16 sulfamethoxazole-trimethoprim.. 22 tgq 15dm/5peh/2cpm...... 44 tretinoin...... 24 sulfasalazine...... 56 tgq 30pse/150gfn/15dm...... 44 TREXBROM...... 45 sulfurated lime...... 52 tgq 30pse/3brm/15dm...... 44 triactin chest congestion...... 45 sulindac...... 4 tgt lubricant eye drops...... 88 triamcinolone acetonide. 52, 80, 84 sumatriptan succinate...... 75 THEO-24...... 10 TRIAMINIC CHEST/NASAL super b complex/vitamin c...... 83 THEOCHRON...... 10 CONGEST...... 45 super strength sinadrin...... 44 theophylline...... 10 TRIAMINIC SUPERVITE EC...... 83 theophylline er...... 10 COLD/ALLERGY CHILD...... 45 supress a pediatric...... 44 theracaps cough/cold reliever.... 44 TRIAMINIC COLD/COUGH supress dm pediatric...... 44 THERAFLU MAX-D COLD DAY TIME...... 45 SUPRESS-PE PEDIATRIC.....44 & FLU...... 44 TRIAMINIC COUGH & sure comfort insulin syringe...... 72 THERAFLU SEVERE COLD SORE THROAT...... 45 sure comfort pen needles...... 72 & COUGH...... 45 TRIAMINIC SURE-FINE PEN NEEDLES.. 72 THERAFLU SEVERE COLD COUGH/RUNNY NOSE...... 19 SURE-JECT INSULIN DAYTIME...... 45 TRIAMINIC COUGH/SORE SYRINGE...... 72 THERANATAL COMPLETE 83 THROAT...... 45 SURE-T INFUSION SET 18". 72 therapeutic liquid...... 83 TRIAMINIC NIGHT TIME SURE-T INFUSION SET 23". 72 THERATEARS PF...... 88 COLD/CGH...... 45 SURE-T INFUSION SET 32". 72 thiamine...... 98 triamterene-hctz...... 54 surgical dressing...... 72 thiothixene...... 25 triazolam...... 60 SYEDA...... 33 thyroid...... 92 trifluoperazine hcl...... 25 SYMJEPI...... 96 ticlopidine hcl...... 57 trifluridine...... 88 SYNAGIS...... 89 timolol maleate...... 29, 88 trigofen dm...... 45 SYNATEK...... 83 TIMOPTIC OCUDOSE...... 88 trihexyphenidyl hcl...... 24 SYNJARDY...... 16 tinidazole...... 22 TRILYTE...... 62 SYNJARDY XR...... 16 TIVICAY...... 28 trimethobenzamide hcl...... 17 SYNTHROID...... 92 tizanidine hcl...... 83 trimethoprim...... 22 syringe luer slip...... 72 tl icon...... 59 trinatal rx 1...... 83 syrpalta...... 90 TOBRADEX...... 88 TRINESSA (28)...... 33 SYRPALTA (RED)...... 90 tobramycin...... 88 TRINESSA LO...... 33 SYRSPEND SF...... 90 tobramycin-dexamethasone...... 88 triple paste af...... 52 SYSTANE...... 88 TOBREX...... 88 TRISPEC DMX...... 45 SYSTANE OVERNIGHT todays health mini pen needles... 72 TRISPEC PSE PEDIATRIC... 45 THERAPY...... 88 todays health pen needles...... 72 TRIUMEQ...... 28 TABLOID...... 24 todays health short pen needle....72 tri-vit/fluoride...... 83 tacrolimus...... 79 tolterodine tartrate...... 94 tri-vitamin/fluoride...... 83 tamoxifen citrate...... 24 tolterodine tartrate er...... 94 TRIVORA (28)...... 33 tamsulosin hcl...... 57 topcare clickfine pen needles...... 72 trixaicin hp...... 52 TARON-BC...... 83 topcare ultra comfort ins syr...... 72 tropicamide...... 88 TAZTIA XT...... 30 topiramate...... 12 trospium chloride...... 94 tbc...... 52 torsemide...... 54 trospium chloride er...... 94 telmisartan...... 21 TOUJEO SOLOSTAR...... 16 TRUEPLUS INSULIN temazepam...... 60 TOVIAZ...... 94 SYRINGE...... 73 tenofovir disoproxil fumarate..... 28 tramadol hcl...... 6 trymine cg...... 45 terazosin hcl...... 21 trandolapril...... 21 turpentine...... 32

112 TUSICOF...... 45 valproic acid...... 12 VICKS NYQUIL TUSNEL...... 45 valsartan...... 21 CHILDRENS CLD/CGH...... 46 TUSNEL C...... 45 valsartan-hydrochlorothiazide... 21 VICKS NYQUIL COLD & TUSNEL PEDIATRIC...... 45 value health insulin syringe...... 74 FLU NIGHT...... 46 tussafex ex...... 45 valumark pen needles...... 74 VICTOZA...... 16 tussafex-a...... 45 VANACOF APE...... 46 VIDA MIA UNIFINE tussin cf cough & cold...... 45 VANACOF G...... 46 PENTIPS...... 74 tussin cf max multi-symptom...... 45 VANACOF GPE...... 46 VIDEX...... 28 tussin chest congestion...... 45 VANACOF-8...... 46 VINATE II...... 83 tussin cold/congestion...... 45 VANATAB DX...... 46 VINATE M...... 83 tussin cough...... 46 vancomycin hcl...... 22 VIOKACE...... 53 tussin dm max...... 46 VANISHPOINT 18GX1-1/4" VIRACEPT...... 28 tussi-pres b...... 46 FEP...... 74 virdec...... 46 TUSSLIN...... 46 VANISHPOINT 18GX1-1/4" virdec dm...... 46 TUSSLIN PEDIATRIC...... 46 PUR...... 74 VIREAD...... 28 TWIRLA...... 34 VANISHPOINT 20GX1-1/4" virt-vite gt...... 83 TYLENOL CHILDRENS FEP...... 74 VISINE TEARS...... 88 COLD/STUFFY...... 46 VANISHPOINT 20GX1-1/4" vita-c...... 98 TYLENOL CHILDRENS PUR...... 74 VITALINE BUFFERED PLUS CLD/CGH...... 46 VANISHPOINT 22GX1" FEP 74 ZINC-220...... 78 UDAMIN SP...... 83 VANISHPOINT 22GX1" vitamin b1...... 98 ULTICARE INSULIN PUR...... 74 vitamin b-1...... 98 SAFETY SYR...... 73 VANISHPOINT 24GX3/4" vitamin b-12...... 59 ULTICARE INSULIN FEP...... 74 vitamin b-2...... 98 SYRINGE...... 73 VANISHPOINT 24GX3/4" vitamin b6...... 98 ULTICARE MICRO PEN PUR...... 74 vitamin b-6...... 98 NEEDLES...... 73 VANISHPOINT INSULIN vitamin b-6 er...... 98 ULTICARE MINI PEN SYRINGE...... 74 vitamin c...... 98 NEEDLES...... 73 VANISHPOINT SYRINGE.....74 vitamin c (calcium ascorbate).....98 ULTICARE PEN NEEDLES...73 vaporizing steam...... 46 vitamin c drops...... 98 ULTICARE SHORT PEN VASOCLEAR-A...... 88 vitamin c er...... 98 NEEDLES...... 73 VASOLEX...... 52 vitamin c gummie...... 98 ULTICARE SYRINGE...... 73 VAZOBID-PD...... 46 vitamin c-electrolytes...... 83 ULTILET INSULIN VELIVET...... 34 vitamin c-rose hips er...... 98 SYRINGE SHORT...... 73 venlafaxine hcl...... 13 vitamin d (cholecalciferol)...... 98 ULTILET PEN NEEDLE...... 73 venlafaxine hcl er...... 13 vitamin d (ergocalciferol)...... 98 ultra comfort insulin syringe...... 73 VENTOLIN HFA...... 10 vitamin d3...... 98 ultra-comfort insulin syringe...... 73 verapamil hcl...... 30 vitamin e...... 98 ultra-mega...... 83 verapamil hcl er...... 30 vitamin k (phytonadione)...... 98 ULTRA-THIN II INS SYR VERSAFREE...... 90 vp insulin syringe...... 74 SHORT...... 73 VERSAPLUS...... 90 V-R MONO INSULIN ULTRESA...... 53 VESICARE...... 94 SYRINGE...... 74 undecylenic acid...... 32 VIBRAMYCIN...... 92 VYVANSE...... 2 UNIFINE PENTIPS...... 73 VICKS DAYQUIL MUCUS WAL-DRYL PE ALLERGY UNIFINE PENTIPS PLUS...... 73 CONTROL DM...... 46 & SINUS...... 46 UNITHROID...... 92 VICKS DAYQUIL SEVERE WAL-FLU COLD & SORE UPCAL D...... 78 COLD/FLU...... 46 THROAT...... 46 urea...... 52 VICKS NATURE FUSION WAL-FLU SEVERE COLD URO-MAG...... 7 COLD & FLU...... 46 DAYTIME...... 46 ursodiol...... 56 VICKS NATURE FUSION wal-som...... 60 VACUTAINER TUBING...... 73 CONGEST...... 46 warfarin sodium...... 11 valacyclovir hcl...... 28 warm mist vaporizer...... 74

113 wee care...... 59 wegmans unifine pentips plus..... 74 WESTHROID...... 92 WIDE-SEAL DIAPHRAGM 60...... 74 WIDE-SEAL DIAPHRAGM 65...... 74 WIDE-SEAL DIAPHRAGM 70...... 74 WIDE-SEAL DIAPHRAGM 75...... 74 WIDE-SEAL DIAPHRAGM 80...... 74 WIDE-SEAL DIAPHRAGM 85...... 74 WIDE-SEAL DIAPHRAGM 90...... 74 WIDE-SEAL DIAPHRAGM 95...... 74 WP THYROID...... 92 XARELTO...... 11 yl oyster shell calcium/d...... 79 zaleplon...... 60 ZARAH...... 34 ZARXIO...... 59 ZEASORB-AF...... 52 ZENCHENT...... 34 ZENPEP...... 53 zidovudine...... 28 zinc...... 83 ZINC 15...... 79 zinc sulfate...... 79 ziprasidone hcl...... 25 ZODRYL DEC 25...... 47 ZODRYL DEC 30...... 47 ZODRYL DEC 35...... 47 ZODRYL DEC 40...... 47 zolmitriptan...... 75 zolpidem tartrate...... 60 zolpidem tartrate er...... 60 zonisamide...... 12 ZOSTAVAX...... 96 ZOVIA 1/50E (28)...... 34 Z-TUSS AC...... 47 ZUMANDIMINE...... 34 ZYNCOF...... 47

114