Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective May 15, 2015

Transcription

1 TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML TC 150 MG TABLET ORL TAB GSK TAB TC 300 MG TABLET ORL TAB GSK TAB BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G BENZAGEL 5% TOPICAL LOTION TOP LOT NVC ML % DEXTROSE & 0.45% NACL W 0.15% KCL 20 MEQ INJ INJ DEFAUL BAX ML HTP 100 MG CAPSULE ORL CAP VTH CAP ABBOTT-TOPIRAMATE 100 MG TABLET ORL TAB ABB TAB ABBOTT-TOPIRAMATE 200 MG TABLET ORL TAB ABB TAB ABBOTT-TOPIRAMATE 25 MG TABLET ORL TAB ABB TAB ABELCET 5MG/ML LIPID COMPLEX INJECTION INJ DEFAUL SGM ML ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP ABILIFY MAINTENA 300 MG/VIAL INJECTION INJ DEFAUL OTS VIAL ABILIFY MAINTENA 400 MG/VIAL INJECTION INJ DEFAUL OTS VIAL ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL ABREVA 10% TOPICAL CREAM TOP CRM GKC G ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB AC & C 8 MG TABLET ORL TAB PPH TAB AC WITH CODEINE 8 MG TABLET ORL TAB DTC TAB ACCEL-ALENDRONATE 10 MG TABLET ORL TAB ACP TAB ACCEL-ALENDRONATE 70 MG TABLET ORL TAB ACP TAB ACCEL-AMLODIPINE 10 MG TABLET ORL TAB ACP TAB ACCEL-AMLODIPINE 5 MG TABLET ORL TAB ACP TAB ACCEL-CELECOXIB 100 MG CAPSULE ORL CAP ACP CAP ACCEL-CELECOXIB 200 MG CAPSULE ORL CAP ACP CAP ACCEL-DONEPEZIL 10 MG TABLET ORL TAB ACP TAB ACCEL-DONEPEZIL 5 MG TABLET ORL TAB ACP TAB ACCEL-FLUOXETINE 10 MG CAPSULE ORL CAP ACP CAP ACCEL-FLUOXETINE 20 MG CAPSULE ORL CAP ACP CAP ACCEL-QUETIAPINE 100 MG TABLET ORL TAB ACP TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 1 of 118

2 ACCEL-QUETIAPINE 200 MG TABLET ORL TAB ACP TAB ACCEL-QUETIAPINE 25 MG TABLET ORL TAB ACP TAB ACCEL-QUETIAPINE 300 MG TABLET ORL TAB ACP TAB ACCEL-TOPIRAMATE 100 MG TABLET ORL TAB ACP TAB ACCEL-TOPIRAMATE 200 MG TABLET ORL TAB ACP TAB ACCEL-TOPIRAMATE 25 MG TABLET ORL TAB ACP TAB ACEBUTOLOL MG TABLET ORL TAB PDL TAB ACEBUTOLOL MG TABLET ORL TAB PDL TAB ACEBUTOLOL MG TABLET ORL TAB PDL TAB ACET 160 MG RECTAL SUPPOSITORY RT SUP PPH SUP ACET CODEINE 30 TABLET ORL TAB PMS TAB ACETAMINOPHEN 300MG/15MG CAFFEINE/8MG COD. CAPLET ORL TAB VTH TAB ACETAMINOPHEN 325 MG TABLET ORL TAB WAM TAB ACETAMINOPHEN 325 MG TABLET ORL TAB VTH TAB ACETAMINOPHEN 500 MG TABLET ORL TAB TLI TAB ACETAMINOPHEN 80 MG/ML ORAL DROPS ORL DPS TLI ML ACETAMINOPHEN ARTHRITIS PAIN 650 MG EXT.REL TABLET ORL ERT PRI TAB ACETAMINOPHEN CAFFEINE & CODEINE 8 MG TABLET ORL TAB WTR TAB ACETAMINOPHEN COMPOUND WITH CODEINE CAPLET ORL TAB PPH TAB ACETAMINOPHEN COMPRIME A CROQUER 80 MG ORL TAB TLI TAB ACETAMINOPHEN EXT STR EASY TO SWALLOW 500 MG TAB ORL TAB PMT TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB PMT TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB VTH TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB WTR TAB ACETAMINOPHEN EXTRA-STRENGTH 500 MG TABLET ORL TAB TAN TAB ACETAMINOPHEN ORAL SOLUTION FOR CHILDREN USP ORL SOL TLI ML ACETAMINOPHEN WITH CODEINE CAPLET ORL TAB ROG TAB ACETAMINOPHEN WITH CODEINE TABLET ORL TAB PMS TAB ACETAMINOPHEN, CAFFEINE & 8 MG CODEINE PHOS. TAB ORL TAB PMT TAB ACETAMINOPHENE 80MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB ACETAZONE FORTE C-8 TABLET ORL TAB RPH TAB ACETAZONE FORTE TABLET ORL TAB RPH TAB ACET-CODEINE 60 MG TABLET ORL TAB PMS TAB ACETYLCYSTEINE 20% INHALATION SOLUTION INH SOL ALV ML ACETYLSALICYLIC ACID 325 MG TABLET ORL TAB PHH TAB ACID REDUCER 75 MG TABLET ORL TAB PMS TAB ACIDOPHILUS PROBIOTIC COMPLETE CAPSULE ORL CAP WNP CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 2 of 118

3 ACIDOPHILUS WITH BIFIDUS CAPSULE ORL CAP WNP CAP ACT ANASTROZOLE 1 MG TABLET ORL TAB APH TAB ACT BETAHISTINE 24 MG TABLET ORL TAB APH TAB ACT CANDESARTAN 4 MG TABLET ORL TAB APH TAB ACT DONEPEZIL ODT 10 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APH TAB ACT DONEPEZIL ODT 5 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APH TAB ACT FAMCICLOVIR 125 MG TABLET ORL TAB APH TAB ACT FAMCICLOVIR 250 MG TABLET ORL TAB APH TAB ACT FAMCICLOVIR 500 MG TABLET ORL TAB APH TAB ACT GLICLAZIDE MR 30 MG SUSTAINED-RELEASE TABLET ORL SRT APH TAB ACT IMATINIB 100 MG TABLET ORL TAB COB TAB ACT IMATINIB 400 MG TABLET ORL TAB COB TAB ACT MELOXICAM 15 MG TABLET ORL TAB APH TAB ACT MELOXICAM 7.5 MG TABLET ORL TAB APH TAB ACT OLANZAPINE 20 MG TABLET ORL TAB APH TAB ACT OLAPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APH ML ACT OLOPATADINE 0.1% OPH SOLUTION OPH SOL APH ML ACT OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT PAROXETINE 10 MG TABLET ORL TAB APH TAB ACT PRAMIPEXOLE 0.5 MG TABLET ORL TAB APH TAB ACT PREGABALIN 150 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 225 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 25 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 300 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 50 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 75 MG CAPSULE ORL CAP APH CAP ACT SILDENAFIL 100 MG TABLET ORL TAB APH TAB ACT SILDENAFIL 25 MG TABLET ORL TAB APH TAB ACT SILDENAFIL 50 MG TABLET ORL TAB APH TAB ACT SUMATRIPTAN 25 MG TABLET ORL TAB APH TAB ACT TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APH CAP ACT TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APH CAP ACT TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APH CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 3 of 118

4 ACT TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APH CAP ACT VALSARTAN 40 MG TABLET ORL TAB APH TAB ACTEMRA 162 MG /0.9 ML INJECTION SYRINGE INJ DEFAUL HLR SYR ACTIFED 60 MG/2.5 MG TABLET ORL TAB PFI TAB ACTIVELLE 1 MG/0.5 MG TABLET ORL TAB NNA TAB ACTIVELLE LD 0.5 MG/0.1 MG TABLET ORL TAB NNA TAB ACTONEL 150 MG TABLET ORL TAB ASC TAB ACTONEL DR 35 MG DELAYED-RELEASE TABLET ORL DRT ASC TAB ACULAR LS 0.4% OPH SOLUTION OPH SOL ALL ML ACYCLOVIR SODIUM 25 MG/ML INJECTION INJ DEFAUL HSP ML ACYCLOVIR SODIUM 50 MG/ML INJECTION INJ DEFAUL PPC ML ACZONE 5% TOPICAL GEL TOP GEL VCL G ADACEL INJECTION INJ DEFAUL SFP ML ADACEL-POLIO INJECTION INJ DEFAUL SFP ML ADALAT XL PLUS 20 MG/81 MG TABLET ORL ERT BAI TAB ADALAT XL PLUS 30 MG/81 MG TABLET ORL ERT BAI TAB ADALAT XL PLUS 60 MG/81 MG TABLET ORL ERT BAI TAB ADASEPT 0.5% TOPICAL LIQUID TOP LIQ ODN ML ADASEPT BP5 ACNE GEL 5% TOPICAL GEL TOP GEL ODN ML ADCETRIS 50MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL STG VIAL ADCIRCA 20 MG TABLET ORL TAB LIL TAB ADDERALL XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADEMPAS 0.5 MG TABLET ORL TAB BAI TAB ADEMPAS 1 MG TABLET ORL TAB BAI TAB ADEMPAS 1.5 MG TABLET ORL TAB BAI TAB ADEMPAS 2 MG TABLET ORL TAB BAI TAB ADEMPAS 2.5 MG TABLET ORL TAB BAI TAB ADRIAMYCIN PFS 2 MG/ML INJECTION INJ DEFAUL PFI ML ADVAGRAF 0.5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP ADVAGRAF 1 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP ADVAGRAF 3 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP ADVAGRAF 5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 4 of 118

5 ADVANCED B COMPLEX ORL CAP AOR CAP ADVICOR 1000 MG/20 MG TABLET ORL TAB SUN TAB ADVICOR 500 MG/20 MG TABLET ORL TAB SUN TAB ADVIL 200 MG TABLET ORL TAB PDH TAB ADVIL COLD AND SINUS CAPLET ORL TAB PDH TAB ADVIL COLD AND SINUS PLUS CAPLET ORL TAB PDH TAB ADVIL EXTRA STRENGTH 400 MG CAPLET ORL TAB PDH TAB ADVIL EXTRA STRENGTH LIQUI-GEL 400 MG CAPSULE ORL CAP PDH CAP ADVIL IBUPROFEN 200 MG CAPLET ORL TAB PDH TAB ADVIL JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB ADVIL LIQUI-GELS 200 MG CAPSULE ORL CAP PDH CAP ADVIL PEDIATRIC 40 MG/ML SUSPENSION DROPS ORL DPS PDH ML AERIUS 5 MG TABLET ORL TAB SCH TAB AFINITOR 10 MG TABLET ORL TAB NOV TAB AFINITOR 2.5 MG TABLET ORL TAB NOV TAB AFINITOR 5 MG TABLET ORL TAB NOV TAB AFINITOR DISPERZ 2 MG TABLET FOR SUSPENSION ORL DTS NOV TAB AFINITOR DISPERZ 3 MG TABLET FOR SUSPENSION ORL DTS NOV TAB AFINITOR DISPERZ 5 MG TABLET FOR SUSPENSION ORL DTS NOV TAB AGENERASE 150 MG CAPSULE ORL CAP GSK CAP AGRIFLU INJECTION SYRINGE INJ DEFAUL NVD SYR AGRYLIN 0.5 MG CAPSULE ORL CAP SHB CAP AHI-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AHI TAB AHI-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AHI TAB A-HYDROCORT 100 MG/VIAL INJECTION INJ DEFAUL HSP VIAL AJ-CISATRACURIUM 2MG/ML WITH PRESERVATIVE INJ INJ DEFAUL AJP ML ALBALON 0.1% OPH SOLUTION OPH SOL ALL ML ALBALON-A OPH SOLUTION OPH SOL ALL ML ALDURAZYME 0.58 MG/ML INJECTION INJ DEFAUL GZM ML ALENDRONATE SODIUM 5 MG TABLET ORL TAB AHI TAB ALEVE 220 MG TABLET ORL TAB BAI TAB ALFUZOSIN 10 MG PROLONGED-RELEASE TABLET ORL SRT PDL TAB ALIGN PROBIOTIC CAPSULE ORL CAP PGI CAP ALIMTA 500 MG/VIAL INJECTION INJ DEFAUL LIL VIAL ALKERAN 2 MG TABLET ORL TAB ASN TAB ALLEGRA 12 HOUR 60 MG TABLET ORL TAB SAV TAB ALLEGRA 24 HOUR 120 MG TABLET ORL TAB SAV TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 5 of 118

6 ALLEGRA-D SUSTAINED-RELEASE TABLET ORL SRT SAV TAB ALLER-AIDE 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML ALLER-AIDE 25 MG CAPLET ORL TAB ROG TAB ALLERDRYL 50 MG CAPSULE ORL CAP VCL CAP ALLERGY 25 MG TABLET ORL TAB TAN TAB ALLERGY DROPS 0.012% OPH SOLUTION OPH SOL BSH ML ALLERGY ELIXIR 2.5 MG/ML ORAL ELIXIR ORL ELX TAN ML ALLERGY FORMULA 25 MG CAPLET ORL TAB PRI TAB ALLERGY RELIEF 10 MG TABLET ORL TAB APX TAB ALLERGY TABLETS EXTRA STRENGTH 50 MG TABLET ORL TAB TAN TAB ALLERNIX 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML ALLERNIX 25 MG CAPLET ORL TAB ROG TAB ALLERNIX EXTRA STRENGTH 50 MG CAPLET ORL TAB ROG TAB ALLERNIX MULTI SYMPTOM 5 MG TABLET ORL TAB ROG TAB ALLER-RELIEF 10 MG TABLET ORL TAB APX TAB ALLER-RELIEF 10 MG TABLET ORL TAB PMS TAB ALLOPURINOL 100 MG TABLET ORL TAB PDL TAB ALLOPURINOL 200 MG TABLET ORL TAB PDL TAB ALLOPURINOL 300 MG TABLET ORL TAB PDL TAB ALMAGEL 200 ORAL LIQUID ORL LIQ ATL ML ALMOTRIPTAN 12.5 MG TABLET ORL TAB PDL TAB ALOCRIL 2% OPH SOLUTION OPH SOL ALL ML ALOMIDE 0.1% (BASE) OPH SOLUTION OPH SOL ALC ML ALOXI 0.05 MG/ML INJECTION INJ DEFAUL EIS ML ALOXI 0.5 MG CAPSULE ORL CAP EIS CAP ALPHA LIPOIC ACID 100MG CAPSULE ORL CAP WNP CAP ALPHAGAN P 0.15% OPHTHALMIC SOLUTION OPH SOL ALL ML ALPRAZOLAM-0.25 MG TABLET ORL TAB PDL TAB ALPRAZOLAM-0.5 MG TABLET ORL TAB PDL TAB ALPRAZOLAM-1 1 MG TABLET ORL TAB PDL TAB ALPROSTADIL 0.5 MG/ML INJECTION INJ DEFAUL TEV ML ALREX 0.2% OPHTHALMIC SUSPENSION OPH SUS BSH ML ALTACE 15 MG CAPSULE ORL CAP/TAB VCL CAP AMARYL 1 MG TABLET ORL TAB SAV TAB AMARYL 2 MG TABLET ORL TAB SAV TAB AMARYL 4 MG TABLET ORL TAB SAV TAB AMBISOME 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 6 of 118

7 AMETOP 4% TOPICAL GEL TOP GEL SNE G AMI-HYDRO TABLET ORL TAB PDL TAB AMIKACIN SULFATE 250 MG/ML INJECTION INJ DEFAUL SDZ ML AMITRIPTYLINE 10 MG TABLET ORL TAB PDL TAB AMITRIPTYLINE 25 MG TABLET ORL TAB PDL TAB AMITRIPTYLINE 50 MG TABLET ORL TAB PDL TAB AMLODIPINE 2.5 MG TABLET ORL TAB PDL TAB AMLODIPINE-ODAN 10 MG TABLET ORL TAB ODN TAB AMLODIPINE-ODAN 5 MG TABLET ORL TAB ODN TAB AMOSAN 68.6% MOUTHWASH ORL MWH OLB ML AMOXI-CLAV 500 MG/125 MG TABLET ORL TAB PDL TAB AMOXI-CLAV 875 MG/125 MG TABLET ORL TAB PDL TAB AMPHOJEL 320 MG/5ML ORAL LIQUID ORL LIQ AXC ML AMPHOJEL 600 MG TABLET ORL TAB AUP TAB A-MULSION ORAL LIQUID ORL LIQ SRL ML ANANDRON 50 MG TABLET ORL TAB SAV TAB ANDROGEL (2.5 G/ PACKET) 1% TOPICAL GEL TOP GEL ABB G ANDROGEL (5 G/ PACKET) 1% TOPICAL GEL TOP GEL ABB G ANDROGEL (75 G/PUMP) 1% TOPICAL GEL TOP GEL ABB G ANEXATE 0.1 MG/ ML INJECTION INJ DEFAUL HLR ML ANGELIQ 1 MG/1 MG TABLET ORL TAB BAI TAB ANORO ELLIPTA 62.5 MCG/25MCG INHALATION POWDER INH MIP GSK DOSE ANTHELIOS XL SPF 60 TOPICAL CREAM TOP CRM LRP G ANTHRAFORTE 1 1% TOPICAL OINTMENT TOP ONT MPQ G ANTHRAFORTE 2 2% TOPICAL OINTMENT TOP ONT MPQ G ANTHRASCALP 0.4% TOPICAL LOTION TOP LOT STI ML ANTIBIOTIC TOPICAL OINTMENT USP TOP ONT TAR G ANTI-NAUSEANT 50 MG TABLET ORL TAB VTH TAB ANTIPHLOGISTINE RUB A-535 NO ODOUR 13.3% TOP OINT TOP ONT CHD G ANUSOL 0.5% RECTAL OINTMENT RT ONT WLA G ANUSOL 10 MG RECTAL SUPPOSITORY RT SUP WLA SUP ANUSOL PLUS RECTAL OINTMENT RT ONT WLA G ANUSOL PLUS RECTAL SUPPOSITORY RT SUP WLA SUP ANUZINC 0.5% W/W TOPICAL OINTMENT TOP ONT SDZ G ANUZINC 10 MG RECTAL SUPPOSITORY RT SUP SDZ SUP ANUZINC PLUS RECTAL OINTMENT RT ONT SDZ G ANZEMET 100 MG TABLET ORL TAB SAV TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 7 of 118

8 AOR CHROMIUM PICOLINATE 600 MCG CAPSULE ORL CAP AOR CAP AOR N.A.C. 500 MG CAPSULE ORL CAP AOR CAP APO-ACETAMINOPHEN 325 MG CAPLET ORL TAB APX TAB APO-ACETAMINOPHEN 325 MG TABLET ORL TAB APX TAB APO-ADEFOVIR 10 MG TABLET ORL TAB APX TAB APO-ALENDRONATE 5 MG TABLET ORL TAB APX TAB APO-ALPRAZ 1 MG TABLET ORL TAB APX TAB APO-ALPRAZ TS 2 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/10 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/20 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/40 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/80 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/10 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/20 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/40 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/80 MG TABLET ORL TAB APX TAB APO-AMOXI CLAV 80 MG/11.4 MG/ML ORAL SUSPENSION ORL SUS APX ML APO-ANASTROZOLE 1 MG TABLET ORL TAB APX TAB APO-ASEN ECT 325 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-ASEN ECT 650 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-ATOMOXETINE 10 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 100 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 18 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 25 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 40 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 60 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 80 MG CAPSULE ORL CAP APX CAP APO-AZITHROMYCIN 250 MG TABLET ORL TAB APX TAB APO-BICALUTAMIDE 50 MG TABLET ORL TAB APX TAB APO-BOSENTAN 125 MG TABLET ORL TAB APX TAB APO-BOSENTAN 62.5 MG TABLET ORL TAB APX TAB APO-BRIMONIDINE P 0.15% OPHTHALMIC SOLUTION OPH SOL APX ML APO-BUTORPHANOL 10 MG/ML NASAL SPRAY NAS SPR APX ML APO-CAL MG TABLET ORL TAB APX TAB APO-CAL 500 MG TABLET ORL TAB APX TAB APO-CANDESARTAN 4 MG TABLET ORL TAB APX TAB APO-CAPTO 100 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 8 of 118

9 APO-CAPTO 12.5 MG TABLET ORL TAB APX TAB APO-CAPTO 25 MG TABLET ORL TAB APX TAB APO-CAPTO 50 MG TABLET ORL TAB APX TAB APO-CAPTO 6.25 MG TABLET ORL TAB APX TAB APO-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS APX ML APO-CETIRIZINE 10 MG TABLET ORL TAB APX TAB APO-CHLORPROPAMIDE 100 MG TABLET ORL TAB APX TAB APO-CHLORPROPAMIDE 250 MG TABLET ORL TAB APX TAB APO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL APX G APO-CIMETIDINE 800 MG TABLET ORL TAB APX TAB APO-CIPROFLOX 0.3% OPHTHALMIC SOL. OPH SOL APX ML APO-CLARITHROMYCIN 250 MG TABLET ORL TAB APX TAB APO-CLARITHROMYCIN 500 MG TABLET ORL TAB APX TAB APO-DICLO RAPIDE 50 MG TABLET ORL TAB APX TAB APO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL APX ML APO-DILTIAZ TZ 120 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP APO-DILTIAZ TZ 180 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP APO-DILTIAZ TZ 240 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP APO-DILTIAZ TZ 300 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP APO-DILTIAZ TZ 360 MG EXTENDED-RELEASE CAPSULE ORL ERC APX CAP APO-DORZOLAMIDE 2% OPHTHALMIC SOLUTION OPH SOL APX ML APO-ELETRIPTAN 20 MG TABLET ORL TAB APX TAB APO-ELETRIPTAN 40 MG TABLET ORL TAB APX TAB APO-ENALAPRIL MALEATE/HCTZ 10 MG/25 MG TABLET ORL TAB APX TAB APO-ENALAPRIL MALEATE/HCTZ 5 MG/12.5 MG TABLET ORL TAB APX TAB APO-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APX TAB APO-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT APX TAB APO-EXEMESTANE 25 MG TABLET ORL TAB APX TAB APO-FAMCICLOVIR 125 MG TABLET ORL TAB APX TAB APO-FAMCICLOVIR 250 MG TABLET ORL TAB APX TAB APO-FAMCICLOVIR 500 MG TABLET ORL TAB APX TAB APO-FERROUS GLUCONATE 300 MG TABLET ORL TAB APX TAB APO-FERROUS SULFATE-FC 300 MG TABLET ORL TAB APX TAB APO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM APX DOSE APO-FROVATRIPTAN 2.5 MG TABLET ORL TAB APX TAB APO-GABAPENTIN 600 MG TABLET ORL TAB APX TAB APO-GABAPENTIN 800 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 9 of 118

10 APO-GAIN 2% TOPICAL SOLUTION TOP SOL APX ML APO-GLICLAZIDE MR 60 MG SUSTAINED-RELEASE TABLET ORL SRT APX TAB APO-GLIMEPIRIDE 1 MG TABLET ORL TAB APX TAB APO-GLIMEPIRIDE 2 MG TABLET ORL TAB APX TAB APO-GLIMEPIRIDE 4 MG TABLET ORL TAB APX TAB APO-HALOPERIDOL 0.5 MG TABLET ORL TAB APX TAB APO-HALOPERIDOL 1 MG TABLET ORL TAB APX TAB APO-HALOPERIDOL 10 MG TABLET ORL TAB APX TAB APO-HYDRO 12.5 MG TABLET ORL TAB APX TAB APO-IBUPROFEN 200 MG TABLET ORL TAB APX TAB APO-IMATINIB 100 MG TABLET ORL TAB APX TAB APO-IMATINIB 400 MG TABLET ORL TAB APX TAB APO-LAMIVUDINE 150 MG TABLET ORL TAB APX TAB APO-LAMIVUDINE 300 MG TABLET ORL TAB APX TAB APO-LAMIVUDINE-ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB APX TAB APO-LETROZOLE 2.5 MG TABLET ORL TAB APX TAB APO-LINEZOLID 600 MG TABLET ORL TAB APX TAB APO-LISINOPRIL/HCTZ 10 MG/12.5 MG TABLET ORL TAB APX TAB APO-LISINOPRIL/HCTZ 20 MG/12.5 MG TABLET ORL TAB APX TAB APO-LISINOPRIL/HCTZ 20 MG/25 MG TABLET ORL TAB APX TAB APO-LORATADINE 10 MG TABLET ORL TAB APX TAB APO-MELOXICAM 15 MG TABLET ORL TAB APX TAB APO-MELOXICAM 7.5 MG TABLET ORL TAB APX TAB APO-MEMANTINE 10 MG TABLET ORL TAB APX TAB APO-METFORMIN ER 500 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-METHIMAZOLE 5 MG TABLET ORL TAB APX TAB APO-METHYLPHENIDATE 5 MG TABLET ORL TAB APX TAB APO-METOPROLOL SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT APX TAB APO-METOPROLOL SR 200 MG SUSTAINED-RELEASE TABLET ORL SRT APX TAB APO-MIRTAZAPINE 15 MG TABLET ORL TAB APX TAB APO-MIRTAZAPINE 45 MG TABLET ORL TAB APX TAB APO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP APX CAP APO-MYCOPHENOLATE 500 MG TABLET ORL TAB APX TAB APO-MYCOPHENOLIC ACID 180 MG ENTERIC-COATED TAB ORL ECT APX TAB APO-MYCOPHENOLIC ACID 360 MG ENTERIC-COATED TAB ORL ECT APX TAB APO-NAPROXEN EC 250 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-NARATRIPTAN 1 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 10 of 118

11 APO-NARATRIPTAN 2.5 MG TABLET ORL TAB APX TAB APO-NITRAZEPAM 10 MG TABLET ORL TAB APX TAB APO-NITRAZEPAM 5 MG TABLET ORL TAB APX TAB APO-NIZATIDINE 150 MG CAPSULE ORL CAP APX CAP APO-NIZATIDINE 300 MG CAPSULE ORL CAP APX CAP APO-NORTRIPTYLINE 10 MG CAPSULE ORL CAP APX CAP APO-NORTRIPTYLINE 25 MG CAPSULE ORL CAP APX CAP APO-OLANZAPINE 20 MG TABLET ORL TAB APX TAB APO-OLANZAPINE ODT 15 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APX TAB APO-OLANZAPINE ODT 20 MG ORALLY DISINTEGRATING TAB ORL DISNTAB APX TAB APO-OLOPATADINE 0.1% OPH SOLUTION OPH SOL APX ML APO-OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APX ML APO-OXAPROZIN 600 MG TABLET ORL TAB APX TAB APO-OXCARBAZEPINE 150 MG TABLET ORL TAB APX TAB APO-OXCARBAZEPINE 300 MG TABLET ORL TAB APX TAB APO-OXCARBAZEPINE 600 MG TABLET ORL TAB APX TAB APO-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 15 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 30 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 60 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-PACLITAXEL 6 MG/ML INJECTION INJ DEFAUL APX ML APO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-PAROXETINE 10 MG TABLET ORL TAB APX TAB APO-PINDOL 10 MG TABLET ORL TAB APX TAB APO-PINDOL 15 MG TABLET ORL TAB APX TAB APO-PINDOL 5 MG TABLET ORL TAB APX TAB APO-PIOGLITAZONE 15 MG TABLET ORL TAB APX TAB APO-PIOGLITAZONE 30 MG TABLET ORL TAB APX TAB APO-PIOGLITAZONE 45 MG TABLET ORL TAB APX TAB APO-PIROXICAM 10 MG CAPSULE ORL CAP APX CAP APO-PIROXICAM 20 MG CAPSULE ORL CAP APX CAP APO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB APX TAB APO-PREDNISONE 1 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 11 of 118

12 APO-PREGABALIN 150 MG CAPSULE ORL CAP APX CAP APO-PREGABALIN 225 MG CAPSULE ORL CAP APX CAP APO-PREGABALIN 25 MG CAPSULE ORL CAP APX CAP APO-PREGABALIN 300 MG CAPSULE ORL CAP APX CAP APO-PREGABALIN 50 MG CAPSULE ORL CAP APX CAP APO-PREGABALIN 75 MG CAPSULE ORL CAP APX CAP APO-PROPRANOLOL 20 MG TABLET ORL TAB APX TAB APO-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB APX CAP APO-RISEDRONATE 150 MG TABLET ORL TAB APX TAB APO-RISPERIDONE 1 MG/ML ORAL SOLUTION ORL SOL APX ML APO-SILDENAFIL 100 MG TABLET ORL TAB APX TAB APO-SILDENAFIL 25 MG TABLET ORL TAB APX TAB APO-SILDENAFIL 50 MG TABLET ORL TAB APX TAB APO-SILDENAFIL R 20 MG TABLET ORL TAB APX TAB APO-SUCRALFATE 1 G TABLET ORL TAB APX TAB APO-SULIN 150 MG TABLET ORL TAB APX TAB APO-SULIN 200 MG TABLET ORL TAB APX TAB APO-TAMOX 10 MG TABLET ORL TAB APX TAB APO-TAMOX 20 MG TABLET ORL TAB APX TAB APO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 180 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APX CAP APO-TICLOPIDINE 250 MG TABLET ORL TAB APX TAB APO-TIMOL 10 MG TABLET ORL TAB APX TAB APO-TIMOL 20 MG TABLET ORL TAB APX TAB APO-TIMOL 5 MG TABLET ORL TAB APX TAB APO-TIMOP GEL 0.5% OPHTHALMIC SOLUTION OPH LAS APX ML APO-TIZANIDINE 4 MG TABLET ORL TAB APX TAB APO-TRAMADOL 50 MG TABLET ORL TAB APX TAB APO-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APX TAB APO-TRAZODONE 150 MG TABLET ORL TAB APX TAB APO-VALPROIC 250 MG CAPSULE ORL CAP APX CAP APO-VALSARTAN 40 MG TABLET ORL TAB APX TAB APO-ZIDOVUDINE 100 MG CAPSULE ORL CAP APX CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 12 of 118

13 APO-ZOLPIDEM ODT 10 MG SUBLINGUAL DISINT TABLET SLG DISNTAB APX TAB APO-ZOLPIDEM ODT 5 MG SUBLINGUAL DISINT TABLET SLG DISNTAB APX TAB APPRILON 40 MG MODIFIED RELEASE CAPSULE ORL MRC GAL CAP APRESOLINE 20 MG/VIAL INJECTION INJ DEFAUL STM VIAL APTIOM 200 MG TABLET ORL TAB SUN TAB APTIOM 400 MG TABLET ORL TAB SUN TAB APTIOM 600 MG TABLET ORL TAB SUN TAB APTIOM 800 MG TABLET ORL TAB SUN TAB APTIVUS 250 MG CAPSULE ORL CAP BOE CAP AQUASOL E 50 UNIT/ML ORAL DROPS ORL DPS NOV ML ARICEPT RDT 10 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB ARICEPT RDT 5 MG ORALLY DISINTEGRATING TABLET ORL DISNTAB PFI TAB ARIMIDEX 1 MG TABLET ORL TAB AZC TAB ARNICA 7% GEL TOP GEL BCI G ARNICA GEL-CREAM RUB A535 TOPICAL GEL TOP GEL CHD G AROMASIN 25 MG TABLET ORL TAB PFI TAB ARTHRITIS PAIN 650 MG EXTENDED RELIEF TABLET ORL ERT VTH TAB ARTHRITIS PAIN RELIEF 650 MG EXTENDED-RELEASE TAB ORL ERT VTH TAB ARTIFICIAL TEARS EXTRA OPH SOLUTION OPH SOL PMS ML ARTIFICIAL TEARS OPH SOLUTION OPH SOL PPH ML ARZERRA 100 MG/5 ML VIAL INJECTION INJ DEFAUL GSK VIAL ARZERRA 1000 MG/50 ML VIAL INJECTION INJ DEFAUL GSK VIAL ASA & CODEINE 8 MG TABLET ORL TAB SDR TAB ASA 325 MG TABLET ORL TAB VTH TAB ASA 325 MG TABLET ORL TAB WAM TAB ASA 325 MG TABLET ORL TAB TEV TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT VTH TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASA EC 81 MG ENTERIC-COATED TABLET ORL ECT SNS TAB ASADOL 325 MG ENTERIC-COATED TABLET ORL ECT PPH TAB ASAPHEN 80 MG TABLET ORL TAB PMS TAB ASAPHEN 81 MG CHEWABLE TABLET ORL CTB PMS TAB ASAPHEN E.C. 80 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASAPHEN E.C. 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASATAB 80 MG CHEWABLE TABLET ORL CTB ODN TAB ASATAB EC 325 MG ENTERIC-COATED TABLET ORL ECT ODN TAB ASCORBIC ACID 500 MG TABLET ORL TAB PMT TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 13 of 118

14 ASPERCREME CREME RUB 10% TOPICAL CREAM TOP CRM SLL G ASPIRIN 325 MG TABLET ORL TAB BAI TAB ASPIRIN STOMACH GUARD EXTRA STRENGTH 500 MG CAPLET ORL TAB BIC TAB ASPIRIN WITH STOMACH GUARD EXTRA STRENGTH CAPLET ORL TAB BAI TAB ATACAND 4 MG TABLET ORL TAB AZC TAB ATASOL 325 MG TABLET ORL TAB CHD TAB ATASOL FORTE 500 MG TABLET ORL TAB CHD TAB ATASOL-15 TABLET ORL TAB CHD TAB ATASOL-30 TABLET ORL TAB CHD TAB ATASOL-8 TABLET ORL TAB CHD TAB ATENOLOL 25 MG TABLET ORL TAB PDL TAB ATENOLOL-100 MG TABLET ORL TAB PDL TAB ATENOLOL-50 MG TABLET ORL TAB PDL TAB ATOMOXETINE 10 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 18 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 25 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 40 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 60 MG CAPSULE ORL CAP PDL CAP ATORVASTATIN 10 MG TABLET ORL TAB SIV TAB ATORVASTATIN 10 MG TABLET ORL TAB APX TAB ATORVASTATIN 10 MG TABLET ORL TAB PDL TAB ATORVASTATIN 20 MG TABLET ORL TAB APX TAB ATORVASTATIN 20 MG TABLET ORL TAB SIV TAB ATORVASTATIN 20 MG TABLET ORL TAB PDL TAB ATORVASTATIN 40 MG TABLET ORL TAB PDL TAB ATORVASTATIN 40 MG TABLET ORL TAB APX TAB ATORVASTATIN 40 MG TABLET ORL TAB SIV TAB ATORVASTATIN 80 MG TABLET ORL TAB SIV TAB ATORVASTATIN 80 MG TABLET ORL TAB APX TAB ATORVASTATIN 80 MG TABLET ORL TAB PDL TAB ATORVASTATIN MG TABLET ORL TAB PDL TAB ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB SNS TAB ATRIANCE 5 MG/ML INJECTION INJ DEFAUL GSK ML ATRIPLA TABLET ORL TAB BMG TAB ATROPINE 0.6 MG/ML INJECTION INJ DEFAUL ALV ML ATROPINE SULFATE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML ATROVENT 0.06% NASAL SPRAY NAS SPR BOE ML Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 14 of 118

15 AURALGAN OTIC SOLUTION OT SOL PAL ML AURO-ATORVASTATIN 10 MG TABLET ORL TAB AUR TAB AURO-ATORVASTATIN 20 MG TABLET ORL TAB AUR TAB AURO-ATORVASTATIN 40 MG TABLET ORL TAB AUR TAB AURO-ATORVASTATIN 80 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN HCT 16 MG/12.5 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN HCT 32 MG/12.5 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN HCT 32 MG/25 MG TABLET ORL TAB AUR TAB AURO-CARVEDILOL 12.5 MG TABLET ORL TAB AUR TAB AURO-CARVEDILOL 25 MG TABLET ORL TAB AUR TAB AURO-CARVEDILOL MG TABLET ORL TAB AUR TAB AURO-CARVEDILOL 6.25 MG TABLET ORL TAB AUR TAB AURO-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS AUR ML AURO-CEFPROZIL 250 MG TABLET ORL TAB AUR TAB AURO-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS AUR ML AURO-CEFPROZIL 500 MG TABLET ORL TAB AUR TAB AURO-EFAVIRENZ 600 MG TABLET ORL TAB AUR TAB AURO-FLUOXETINE 10 MG CAPSULE ORL CAP AUR CAP AURO-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB AUR TAB AURO-LOSARTAN HCT 100 MG/12.5 MG TABLET ORL TAB AUR TAB AURO-LOSARTAN HCT 100 MG/25 MG TABLET ORL TAB AUR TAB AURO-LOSARTAN HCT 50 MG/12.5 MG TABLET ORL TAB AUR TAB AURO-MELOXICAM 15 MG TABLET ORL TAB AUR TAB AURO-MELOXICAM 7.5 MG TABLET ORL TAB AUR TAB AURO-METFORMIN 500 MG TABLET ORL TAB AUR TAB AURO-METFORMIN 850 MG TABLET ORL TAB AUR TAB AURO-MIRTAZAPINE 15 MG TABLET ORL TAB AUR TAB AURO-MIRTAZAPINE OD 15 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB AURO-MIRTAZAPINE OD 30 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB AURO-MIRTAZAPINE OD 45 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB AURO-MODAFINIL 100 MG TABLET ORL TAB AUR TAB AURO-NEVIRAPINE 200 MG TABLET ORL TAB AUR TAB AURO-OMEPRAZOLE 10 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT AUR CAP AURO-PIOGLITAZONE 15 MG TABLET ORL TAB AUR TAB AURO-PIOGLITAZONE 30 MG TABLET ORL TAB AUR TAB AURO-PIOGLITAZONE 45 MG TABLET ORL TAB AUR TAB AURO-PRAMIPEXOLE 0.25 MG TABLET ORL TAB AUR TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 15 of 118

16 AURO-PRAMIPEXOLE 1 MG TABLET ORL TAB AUR TAB AURO-PRAMIPEXOLE 1.5 MG TABLET ORL TAB AUR TAB AURO-PREGABALIN 150 MG CAPSULE ORL CAP AUR CAP AURO-PREGABALIN 25 MG CAPSULE ORL CAP AUR CAP AURO-PREGABALIN 50 MG CAPSULE ORL CAP AUR CAP AURO-PREGABALIN 75 MG CAPSULE ORL CAP AUR CAP AURO-SIMVASTATIN 10 MG TABLET ORL TAB AUR TAB AURO-SIMVASTATIN 20 MG TABLET ORL TAB AUR TAB AURO-SIMVASTATIN 40 MG TABLET ORL TAB AUR TAB AURO-SIMVASTATIN 5 MG TABLET ORL TAB AUR TAB AURO-SIMVASTATIN 80 MG TABLET ORL TAB AUR TAB AURO-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB AUR TAB AURO-VALGANCICLOVIR 450 MG TABLET ORL TAB AUR TAB AURO-VALSARTAN 40 MG TABLET ORL TAB AUR TAB AVA-ACEBUTOLOL 100 MG TABLET ORL TAB AVA TAB AVA-ACEBUTOLOL 200 MG TABLET ORL TAB AVA TAB AVA-ACEBUTOLOL 400 MG TABLET ORL TAB AVA TAB AVA-ATENOLOL 25 MG TABLET ORL TAB AVA TAB AVA-AZITHROMYCIN 20 MG/ML ORAL SUSPENSION ORL SUS AVA ML AVA-AZITHROMYCIN 250 MG TABLET ORL TAB AVA TAB AVA-AZITHROMYCIN 40 MG/ML ORAL SUSPENSION ORL SUS AVA ML AVA-BACLOFEN 10 MG TABLET ORL TAB AVA TAB AVA-BACLOFEN 20 MG TABLET ORL TAB AVA TAB AVA-BICALUTAMIDE 50 MG TABLET ORL TAB AVA TAB AVA-BISOPROLOL 10 MG TABLET ORL TAB AVA TAB AVA-BISOPROLOL 5 MG TABLET ORL TAB AVA TAB AVA-BUPROPION SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB AVA-BUPROPION SR 150 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB AVA-CARVEDILOL 12.5 MG TABLET ORL TAB AVA TAB AVA-CARVEDILOL 25 MG TABLET ORL TAB AVA TAB AVA-CARVEDILOL MG TABLET ORL TAB AVA TAB AVA-CARVEDILOL 6.25 MG TABLET ORL TAB AVA TAB AVA-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS AVA ML AVA-CEFPROZIL 250 MG TABLET ORL TAB AVA TAB AVA-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS AVA ML AVA-CEFPROZIL 500 MG TABLET ORL TAB AVA TAB AVA-CITALOPRAM 10 MG TABLET ORL TAB AVA TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 16 of 118

17 AVA-CLARITHROMYCIN 250 MG TABLET ORL TAB AVA TAB AVA-CLARITHROMYCIN 500 MG TABLET ORL TAB AVA TAB AVA-CLINDAMYCIN 150 MG CAPSULE ORL CAP AVA CAP AVA-CLINDAMYCIN 300 MG CAPSULE ORL CAP AVA CAP AVA-CLONIDINE MG TABLET ORL TAB AVA TAB AVA-CLONIDINE 0.1 MG TABLET ORL TAB AVA TAB AVA-DICLOFENAC 25 MG ENTERIC-COATED TABLET ORL ECT AVA TAB AVA-DICLOFENAC 50 MG ENTERIC-COATED TABLET ORL ECT AVA TAB AVA-DICLOFENAC SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB AVA-DICLOFENAC SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT AVA TAB AVA-DOMPERIDONE 10 MG TABLET ORL TAB AVA TAB AVA-ENALAPRIL 10 MG TABLET ORL TAB AVA TAB AVA-ENALAPRIL 2.5 MG TABLET ORL TAB AVA TAB AVA-ENALAPRIL 20 MG TABLET ORL TAB AVA TAB AVA-ENALAPRIL 5 MG TABLET ORL TAB AVA TAB AVA-FAMOTIDINE 20 MG TABLET ORL TAB AVA TAB AVA-FAMOTIDINE 40 MG TABLET ORL TAB AVA TAB AVA-FENOFIBRATE MICRO 200 MG CAPSULE ORL CAP AVA CAP AVA-FLUOXETINE 20 MG CAPSULE ORL CAP AVA CAP AVA-FLUVOXAMINE 100 MG TABLET ORL TAB AVA TAB AVA-FLUVOXAMINE 50 MG TABLET ORL TAB AVA TAB AVA-FUROSEMIDE 20 MG TABLET ORL TAB AVA TAB AVA-FUROSEMIDE 40 MG TABLET ORL TAB AVA TAB AVA-FUROSEMIDE 80 MG TABLET ORL TAB AVA TAB AVA-GLICLAZIDE 80 MG TABLET ORL TAB AVA TAB AVA-GLYBURIDE 2.5 MG TABLET ORL TAB AVA TAB AVA-GLYBURIDE 5 MG TABLET ORL TAB AVA TAB AVA-HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB AVA TAB AVA-HYDROCHLOROTHIAZIDE 50 MG TABLET ORL TAB AVA TAB AVA-IRBESARTAN 150 MG TABLET ORL TAB AVA TAB AVA-IRBESARTAN 300 MG TABLET ORL TAB AVA TAB AVA-IRBESARTAN 75 MG TABLET ORL TAB AVA TAB AVA-IRBESARTAN/HCTZ 150/12.5 MG TABLET ORL TAB AVA TAB AVA-IRBESARTAN/HCTZ 300/12.5 MG TABLET ORL TAB AVA TAB AVA-IRBESARTAN/HCTZ 300/25 MG TABLET ORL TAB AVA TAB AVA-LEVETIRACETAM 250 MG TABLET ORL TAB AVA TAB AVA-LEVETIRACETAM 500 MG TABLET ORL TAB AVA TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 17 of 118

18 AVA-LEVETIRACETAM 750 MG TABLET ORL TAB AVA TAB AVA-LEVOFLOXACIN 250 MG TABLET ORL TAB AVA TAB AVA-LEVOFLOXACIN 500 MG TABLET ORL TAB AVA TAB AVA-LISINOPRIL HCT 10 MG/12.5 MG TABLET ORL TAB AVA TAB AVA-LISINOPRIL HCT 20 MG/12.5 MG TABLET ORL TAB AVA TAB AVA-LISINOPRIL HCT 20 MG/25 MG TABLET ORL TAB AVA TAB AVA-LOVASTATIN 20 MG TABLET ORL TAB AVA TAB AVA-LOVASTATIN 40 MG TABLET ORL TAB AVA TAB AVA-METFORMIN 500 MG TABLET ORL TAB AVA TAB AVA-METFORMIN 850 MG TABLET ORL TAB AVA TAB AVA-METOPROLOL (TYPE L) 100 MG TABLET ORL TAB AVA TAB AVA-METOPROLOL (TYPE L) 50 MG TABLET ORL TAB AVA TAB AVA-METOPROLOL 100 MG TABLET ORL TAB AVA TAB AVA-METOPROLOL 50 MG TABLET ORL TAB AVA TAB AVA-MIRTAZAPINE 30 MG TABLET ORL TAB AVA TAB AVAMYS 27.5 MCG/DOSE NASAL SPRAY NAS SPM GSK DOSE AVA-NAPROXEN 375 MG TABLET ORL TAB AVA TAB AVA-NAPROXEN 500 MG TABLET ORL TAB AVA TAB AVA-NAPROXEN EC 250 MG ENTERIC-COATED TABLET ORL ECT AVA TAB AVA-NAPROXEN EC 375 MG ENTERIC-COATED TABLET ORL ECT AVA TAB AVA-NAPROXEN EC 500 MG ENTERIC-COATED TABLET ORL ECT AVA TAB AVANDAMET 1 MG/500 MG TABLET ORL TAB GSK TAB AVA-NORFLOXACIN 400 MG TABLET ORL TAB AVA TAB AVA-NORTRIPTYLINE 10 MG CAPSULE ORL CAP AVA CAP AVA-NORTRIPTYLINE 25 MG CAPSULE ORL CAP AVA CAP AVA-OLANZAPINE 10 MG TABLET ORL TAB AVA TAB AVA-OLANZAPINE 2.5 MG TABLET ORL TAB AVA TAB AVA-OLANZAPINE 5 MG TABLET ORL TAB AVA TAB AVA-OLANZAPINE 7.5 MG TABLET ORL TAB AVA TAB AVA-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT AVA TAB AVA-PRAMIPEXOLE 0.25 MG TABLET ORL TAB AVA TAB AVA-PRAMIPEXOLE 1 MG TABLET ORL TAB AVA TAB AVA-PRAMIPEXOLE 1.5 MG TABLET ORL TAB AVA TAB AVA-RAMIPRIL 1.25 MG TABLET ORL CAP/TAB AVA TAB AVA-RAMIPRIL 10 MG TABLET ORL CAP/TAB AVA TAB AVA-RAMIPRIL 2.5 MG TABLET ORL CAP/TAB AVA TAB AVA-RAMIPRIL 5 MG TABLET ORL CAP/TAB AVA TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 18 of 118

19 AVA-RISEDRONATE 35 MG TABLET ORL TAB AVA TAB AVA-RISPERIDONE 0.25 MG TABLET ORL TAB AVA TAB AVA-RISPERIDONE 0.5 MG TABLET ORL TAB AVA TAB AVA-RISPERIDONE 1 MG TABLET ORL TAB AVA TAB AVA-RISPERIDONE 1 MG/ML ORAL SOLUTION ORL SOL AVA ML AVA-RISPERIDONE 2 MG TABLET ORL TAB AVA TAB AVA-RISPERIDONE 3 MG TABLET ORL TAB AVA TAB AVA-RISPERIDONE 4 MG TABLET ORL TAB AVA TAB AVA-SOTALOL 160 MG TABLET ORL TAB AVA TAB AVA-SOTALOL 80 MG TABLET ORL TAB AVA TAB AVASTIN 25 MG/ML INJECTION INJ DEFAUL HLR ML AVA-SUMATRIPTAN 100 MG TABLET ORL TAB AVA TAB AVA-SUMATRIPTAN 50 MG TABLET ORL TAB AVA TAB AVA-TAMSULOSIN CR 0.4 MG EXTENDED-RELEASE TABLET ORL ERT AVA TAB AVA-TOPIRAMATE 100 MG TABLET ORL TAB AVA TAB AVA-TOPIRAMATE 200 MG TABLET ORL TAB AVA TAB AVA-TOPIRAMATE 25 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN 160 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN 320 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN 40 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN 80 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN HCT 160 MG/ 25 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN HCT 160 MG/12.5 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN HCT 320 MG/12.5 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN HCT 320 MG/25 MG TABLET ORL TAB AVA TAB AVA-VALSARTAN HCT 80 MG/12.5 MG TABLET ORL TAB AVA TAB AVAXIM 160 U/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR AVAXIM-PEDIATRIC 80 UNIT/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR AVA-ZOPICLONE 5 MG TABLET ORL TAB AVA TAB AVA-ZOPICLONE 7.5 MG TABLET ORL TAB AVA TAB AVEENO CREAM TOP CRM JJI G AVEENO MOISTURIZING BATH TOP PWR JJI G AXIRON 2% TOPICAL SOLUTION TOP SOL LIL ML AZATHIOPRINE 50 MG TABLET ORL TAB SNS TAB AZILECT 0.5 MG TABLET ORL TAB TMP TAB AZILECT 1.0 MG TABLET ORL TAB TMP TAB AZITHROMYCIN 20 MG/ML ORAL SUSPENSION ORL SUS PMS ML Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 19 of 118

20 AZITHROMYCIN 40 MG/ML ORAL SUSPENSION ORL SUS PMS ML AZITHROMYCIN 600 MG TABLET ORL TAB SNS TAB B COMPLEX 50 TABLET ORL TAB JAM TAB B COMPLEX 75 TABLET ORL TAB JAM TAB B COMPLEX PLUS C TABLET ORL TAB JAM TAB B&C VITAMINS TABLET ORL TAB WBP TAB B MCG TABLET ORL TAB WNP TAB B50 COMPLEX CAPSULE ORL CAP WNP CAP BACID 1 B CAPSULE ORL CAP ERF CAP BACIMYXIN TOPICAL OINTMENT TOP ONT PMS G BACITIN 500 UNIT/G TOPICAL OINTMENT TOP ONT PPH G BACITRACIN 50,000 U/VIAL INJECTION INJ DEFAUL PFI VIAL BACLOFEN 10 MG TABLET ORL TAB PDL TAB BACLOFEN 20 MG TABLET ORL TAB PDL TAB BACTERIOSTATIC SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL HSP ML BALANCED B COMPLEX 100 MG SUSTAINED-RELEASE TABLET ORL SRT PMT TAB BALMINIL CODEINE NIGHT TIME + EXPECTORANT ORL SYR ROG ML BALMINIL DM 3 MG/ML ORAL SYRUP ORL SYR ROG ML BALNETAR 2.5% TOPICAL SOLUTION TOP SOL WSD ML BANZEL 100 MG TABLET ORL TAB EIS TAB BANZEL 200 MG TABLET ORL TAB EIS TAB BANZEL 400 MG TABLET ORL TAB EIS TAB BARRIERE 20% TOPICAL CREAM TOP CRM WSP G BASALJEL 500 MG CAPSULE ORL CAP AUP CAP BAZA CLEANSE & PROTECT 2% TOPICAL LOTION TOP LOT COC ML BCG VACCINE (FREEZE-DRIED) 1 MG INJECTION INJ DEFAUL SFP VIAL B-COMPLEX 100 SUSTAINED-RELEASE TABLET ORL SRT JAM TAB BEANO 150 UNIT TABLET ORL TAB GSK TAB BEDUZIL MCG TABLET ORL ERT ORI TAB BENADRYL 12.5 MG/5 ML ORAL ELIXIR ORL ELX PDH ML BENADRYL 2% TOPICAL CREAM TOP CRM WLA G BENADRYL 25 MG CAPLET ORL TAB PDH TAB BENADRYL 50 MG CAPSULE ORL CAP PDH CAP BENADRYL ALLERGY JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB BENADRYL ALLERGY SINUS HEADACHE CAPLET ORL TAB PDH TAB BENADRYL CHILDREN'S 1.25 MG/ML ORAL LIQUID ORL LIQ PDH ML BENADRYL EXTRA STRENGTH 50 MG CAPLET ORL TAB PDH TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 20 of 118