Department of Vermont Health Access Over-the-Counter (OTC) Drugs Report Date: 2/5/2020 DRUG CATEGORY BRAND / PA GENERIC DRUG DESCRIPTION NDC GENERI PRODUCT DESCRIPTION REQUIRED LABELER NAME C ACNE PRODUCTS Adapalene Gel 0.1% GALDERMA 00299491015 B DIFFERIN GEL 0.1% GALDERMA 00299491045 B DIFFERIN GEL 0.1% GALDERMA 00299492030 B DIFFERIN GEL 0.1% GALDERMA 00299492045 B DIFFERIN GEL 0.1% Benzoyl Peroxide Cloth 6% ACELLA PHARMACEUTICALS 42192016160 G BPO CLOTHS MIS 6% Benzoyl Peroxide Gel 10% RUGBY LABORATORIES 00536105656 G ACNE MEDICAT GEL 10% PERRIGO PHARMACEUTICALS 45802030801 G BENZOYL PER GEL 10% PERRIGO PHARMACEUTICALS 45802030896 G BENZOYL PER GEL 10% Benzoyl Peroxide Gel 2.5% PERRIGO PHARMACEUTICALS 45802010196 G BENZOYL PER GEL 2.5% Benzoyl Peroxide Gel 5% RUGBY LABORATORIES 00536105556 G ACNE MEDICAT GEL 5% PERRIGO PHARMACEUTICALS 45802021601 G BENZOYL PER GEL 5% PERRIGO PHARMACEUTICALS 45802021696 G BENZOYL PER GEL 5% Benzoyl Peroxide Liq 10% PERRIGO PHARMACEUTICALS 45802031801 G BENZOYL PER LIQ 10% WASH PERRIGO PHARMACEUTICALS 45802031834 G BENZOYL PER LIQ 10% WASH HARRIS PHARMACEUTICAL 67405083005 G BENZOYL PER LIQ 10% WASH HARRIS PHARMACEUTICAL 67405083008 G BENZOYL PER LIQ 10% WASH GLAXO CONSUMER HEALTHCARE L.P. 00145098505 G PANOXYL WASH LIQ 10% CROWN LABORATORIES 00316022855 G PANOXYL WASH LIQ 10% Benzoyl Peroxide Liq 4% CROWN LABORATORIES 00316022706 G PANOXYL WASH LIQ 4% GLAXO CONSUMER HEALTHCARE L.P. 00145266005 B PANOXYL-4 LIQ CREM WSH Benzoyl Peroxide Liq 5% PERRIGO PHARMACEUTICALS 45802028001 G BENZOYL PER LIQ 5% WASH PERRIGO PHARMACEUTICALS 45802028034 G BENZOYL PER LIQ 5% WASH HARRIS PHARMACEUTICAL 67405082505 G BENZOYL PER LIQ 5% WASH HARRIS PHARMACEUTICAL 67405082508 G BENZOYL PER LIQ 5% WASH Benzoyl Peroxide Liq 6% HARRIS PHARMACEUTICAL 67405083506 B BENZOYL PER LIQ 6% PA REQUIRED HARRIS PHARMACEUTICAL 67405083512 B BENZOYL PER LIQ 6% PA REQUIRED Benzoyl Peroxide Lotion 10% RUGBY LABORATORIES 00536105875 B ACNE MEDICAT LOT 10% PA REQUIRED 2/5/2020 9:59:25 AM Page 1 Of 254 VTPBA-278 Confidential and Proprietary Department of Vermont Health Access Over-the-Counter (OTC) Drugs Report Date: 2/5/2020 DRUG CATEGORY BRAND / PA GENERIC DRUG DESCRIPTION NDC GENERI PRODUCT DESCRIPTION REQUIRED LABELER NAME C ACNE PRODUCTS Benzoyl Peroxide Lotion 5% RUGBY LABORATORIES 00536105775 B ACNE MEDICAT LOT 5% PA REQUIRED ALTERNATIVE MEDICINE - A'S Melatonin SL Tab 3 MG NATURES BOUNTY 74312007901 G MELATONIN SUB 3MG PA REQUIRED NATURES BOUNTY 74312007903 G MELATONIN SUB 3MG PA REQUIRED ALTERNATIVE MEDICINE - M'S Melatonin Cap 1 MG BIO-TECH 53191022601 G MELATONIN CAP 1MG Melatonin Cap 10 MG CVS PHARMACY HEALTHCARE SERV 50428042135 G CVS QUALITY CAP SLEEP REXALL SUNDOWN 30768019484 G MELATONIN CAP 10MG CVS PHARMACY HEALTHCARE SERV 50428030412 G MELATONIN CAP 10MG CVS PHARMACY HEALTHCARE SERV 50428042388 G MELATONIN CAP 10MG CVS PHARMACY HEALTHCARE SERV 50428728624 G MELATONIN CAP 10MG CVS PHARMACY HEALTHCARE SERV 50428866535 G MELATONIN CAP 10MG NATURES BOUNTY 74312019491 G MELATONIN CAP 10MG Melatonin Cap 2.5 MG TYSON 53335031012 G MELATONIN CAP 2.5MG Melatonin Cap 3 MG TWIN LABS 27434000511 G MELATONIN CAP 3MG BIO-TECH 53191022701 G MELATONIN CAP 3MG Melatonin Cap 5 MG CVS PHARMACY HEALTHCARE SERV 50428034400 G MELATONIN CAP 5MG BIO-TECH 53191021401 G MELATONIN CAP 5MG NATURES BOUNTY 74312015745 G MELATONIN CAP 5MG Melatonin Chew Tab 2.5 MG REXALL SUNDOWN 30768053503 G MELATONIN CHW 2.5MG PHARMAVITE 31604004135 G MELATONIN CHW 2.5MG PHARMAVITE 31604004216 G MELATONIN CHW 2.5MG NATROL 47469006398 G MELATONIN CHW 2.5MG CVS PHARMACY HEALTHCARE SERV 50428028011 G MELATONIN CHW 2.5MG CVS PHARMACY HEALTHCARE SERV 50428054198 G MELATONIN CHW 2.5MG CVS PHARMACY HEALTHCARE SERV 50428889927 G MELATONIN CHW 2.5MG NATIONAL VITAMIN 79854009305 G MELATONIN CHW 2.5MG WAL-MART 81131005691 G MELATONIN CHW 2.5MG 21ST CENTURY HEALTHCARE 40985027770 G VITAJOY GUMM CHW 2.5MG Melatonin Liquid 1 MG/4ML (2.5 MG/10ML) NATROL 47469000457 G MELATONIN LIQ 1MG/4ML 2/5/2020 9:59:25 AM Page 2 Of 254 VTPBA-278 Confidential and Proprietary Department of Vermont Health Access Over-the-Counter (OTC) Drugs Report Date: 2/5/2020 DRUG CATEGORY BRAND / PA GENERIC DRUG DESCRIPTION NDC GENERI PRODUCT DESCRIPTION REQUIRED LABELER NAME C ALTERNATIVE MEDICINE - M'S Melatonin Liquid 1 MG/4ML (2.5 MG/10ML) NATROL 47469004408 G MELATONIN LIQ 2.5MG Melatonin Liquid 1 MG/ML WALGREENS 11917018468 G MELATONIN LIQ 1MG/ML REXALL SUNDOWN 30768016836 G MELATONIN LIQ 1MG/ML WAL-MART 81131015112 G MELATONIN LIQ 1MG/ML Melatonin Liquid 3 MG/0.9ML NOW HEALTH GROUP 33739003261 G MELATONIN LIQ 3MG/0.9 PA REQUIRED Melatonin Liquid 5 MG/15ML WALGREENS 11917014142 G MELATONIN LIQ 5MG/15ML CVS PHARMACY HEALTHCARE SERV 50428053791 G MELATONIN LIQ 5MG/15ML CVS PHARMACY HEALTHCARE SERV 50428802565 G MELATONIN LIQ 5MG/15ML Melatonin Liquid 5 MG/ML NATROL 47469007149 G MELATIONIN DRO 5MG/ML PA REQUIRED Melatonin SL Tab 10 MG MCKESSON 52569014167 G HM MELATONIN SUB 10MG LEADER BRAND PRODUCTS 37205098452 G MELATONIN SUB 10MG 21ST CENTURY HEALTHCARE 40985027503 G MELATONIN SUB 10MG NATIONAL VITAMIN 54629092910 G MELATONIN SUB 10MG NATURES BOUNTY 74312052802 G MELATONIN SUB 10MG BERGEN BRUNSWIG 87701042634 G MELATONIN SUB 10MG CVS PHARMACY HEALTHCARE SERV 50428030129 G MELATONIN SUB QUIK DIS Melatonin SL Tab 5 MG WALGREENS 11917019901 G MELATONIN SUB 5MG CVS PHARMACY HEALTHCARE SERV 50428051108 G MELATONIN SUB 5MG NATIONAL VITAMIN 54629061500 G MELATONIN SUB 5MG Melatonin Sublingual Lozenge 5 MG REXALL SUNDOWN 30768052816 G MELATONIN LOZ 5MG Melatonin Tab 1 MG RUGBY LABORATORIES 00536111411 G MELATONIN TAB 1MG RUGBY LABORATORIES 10006073051 G MELATONIN TAB 1MG WALGREENS 11917017180 G MELATONIN TAB 1MG WINDMILL CONSUMER PRODUCTS 35046000391 G MELATONIN TAB 1MG PRINCETON RESEARCH 40093010609 G MELATONIN TAB 1MG MAGNO-HUMPHRIES LABORATORIES 43292056329 G MELATONIN TAB 1MG NATROL 47469000465 G MELATONIN TAB 1MG GERI-CARE 57896088406 G MELATONIN TAB 1MG GERI-CARE 57896088409 G MELATONIN TAB 1MG GERI-CARE 57896088418 G MELATONIN TAB 1MG 2/5/2020 9:59:25 AM Page 3 Of 254 VTPBA-278 Confidential and Proprietary Department of Vermont Health Access Over-the-Counter (OTC) Drugs Report Date: 2/5/2020 DRUG CATEGORY BRAND / PA GENERIC DRUG DESCRIPTION NDC GENERI PRODUCT DESCRIPTION REQUIRED LABELER NAME C ALTERNATIVE MEDICINE - M'S Melatonin Tab 1 MG NATURES BOUNTY 74312002832 G MELATONIN TAB 1MG WAL-MART 78742045610 G MELATONIN TAB 1MG NAT-RUL HEALTH PRODUCTS 94604010075 G MELATONIN TAB 1MG Melatonin Tab 10 MG BASIC DRUGS 00761015724 G MELATONIN TAB 10MG PA REQUIRED WALGREENS 11917017023 G MELATONIN TAB 10MG PA REQUIRED RITE AID CORPORATION 11822054311 G RA MELATONIN TAB 10MG PA REQUIRED RITE AID CORPORATION 11822517570 G RA MELATONIN TAB 10MG PA REQUIRED Melatonin Tab 200 MCG NATURES BOUNTY 74312007900 G MELATONIN TAB 200MCG Melatonin Tab 3 MG KAISER FOUNDATION HOSPITAL 00179842712 G KP MELATONIN TAB 3MG RUGBY LABORATORIES 00536641208 G MELATONIN TAB 3MG RUGBY LABORATORIES 00536641268 G MELATONIN TAB 3MG MAJOR PHARMACEUTICALS 00904518206 G MELATONIN TAB 3MG MAJOR PHARMACEUTICALS 00904518252 G MELATONIN TAB 3MG MAJOR PHARMACEUTICALS 00904518261 G MELATONIN TAB 3MG WAL-MART 05388062808 G MELATONIN TAB 3MG BASIC DRUGS 07610022640 G MELATONIN TAB 3MG MAJOR PHARMACEUTICALS 10006070029 G MELATONIN TAB 3MG MAJOR PHARMACEUTICALS 10006070030 G MELATONIN TAB 3MG MAJOR PHARMACEUTICALS 10006070031 G MELATONIN TAB 3MG RUGBY LABORATORIES 10006070050 G MELATONIN TAB 3MG RUGBY LABORATORIES 10006073044 G MELATONIN TAB 3MG WALGREENS 11917005642 G MELATONIN TAB 3MG WALGREENS 11917007508 G MELATONIN TAB 3MG WALGREENS 11917013961 G MELATONIN TAB 3MG WALGREENS 11917018855 G MELATONIN TAB 3MG REXALL SUNDOWN 30768004005 G MELATONIN TAB 3MG REXALL SUNDOWN 30768048678 G MELATONIN TAB 3MG REXALL SUNDOWN 30768048680 G MELATONIN TAB 3MG PHARMAVITE 31604002741 G MELATONIN TAB 3MG PHARMAVITE 31604002742 G MELATONIN TAB 3MG PHARMAVITE 31604004080 G MELATONIN TAB 3MG WINDMILL CONSUMER PRODUCTS 35046000390 G MELATONIN TAB 3MG LEADER BRAND PRODUCTS 37205050478 G MELATONIN TAB 3MG 21ST CENTURY HEALTHCARE 40985021240 G MELATONIN TAB 3MG 21ST CENTURY HEALTHCARE 40985022721 G MELATONIN TAB 3MG 2/5/2020 9:59:25 AM Page 4 Of 254 VTPBA-278 Confidential and Proprietary Department of Vermont Health Access Over-the-Counter (OTC) Drugs Report Date: 2/5/2020 DRUG CATEGORY BRAND / PA GENERIC DRUG DESCRIPTION NDC GENERI PRODUCT DESCRIPTION REQUIRED LABELER NAME C ALTERNATIVE MEDICINE - M'S Melatonin Tab 3 MG MAGNO-HUMPHRIES LABORATORIES 43292056298 G MELATONIN TAB 3MG MAGNO-HUMPHRIES LABORATORIES 43292056366 G MELATONIN TAB 3MG NATROL 47469000511 G MELATONIN TAB 3MG NATROL 47469005105 G MELATONIN TAB 3MG NATROL 47469016068 G MELATONIN TAB 3MG AVPAK 50268052411 G MELATONIN TAB 3MG AVPAK 50268052415 G MELATONIN TAB 3MG CVS PHARMACY HEALTHCARE SERV 50428031818 G MELATONIN TAB 3MG CVS PHARMACY HEALTHCARE SERV 50428034138 G MELATONIN TAB 3MG CVS PHARMACY HEALTHCARE SERV 50428035025 G MELATONIN TAB 3MG CVS PHARMACY HEALTHCARE SERV 50428300263 G MELATONIN TAB 3MG CVS PHARMACY HEALTHCARE SERV 50428416267 G MELATONIN TAB 3MG CVS PHARMACY HEALTHCARE SERV 50428419642 G MELATONIN TAB 3MG PLUS PHARMA 51645078806 G MELATONIN TAB 3MG BRECKENRIDGE 51991001406 G MELATONIN TAB 3MG BASIC ORGANICS 54458021360 G MELATONIN TAB 3MG A-S MEDICATION SOLUTIONS 54569912300 G MELATONIN TAB 3MG NATIONAL VITAMIN 54629060900 G MELATONIN TAB 3MG GERI-CARE 57896086406 G MELATONIN TAB 3MG PRECISION DOSE, INC 68094011059 G MELATONIN TAB 3MG PRECISION DOSE, INC 68094011061 G MELATONIN