Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective March 14, 2018

Transcription

1 TABLET ORL TAB PPH TAB TABLET ORL TAB PPH TAB 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 % DEXTROSE 500 MG/ML INJECTION USP INJ DEFAUL HSP ML HTP 100 MG CAPSULE ORL CAP VTH CAP AA-CLOZAPINE 200 MG TABLET ORL TAB AAP TAB AA-CLOZAPINE 50 MG TABLET ORL TAB AAP 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 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 ACARIZAX 12 UNIT SQ-HDM TABLET SLG SLT ALK TAB ACCEL-ALENDRONATE 10 MG TABLET ORL TAB ACP TAB ACCEL-ALENDRONATE 70 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN 16 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN 32 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN 8 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN/HCTZ 16 MG/12.5 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN/HCTZ 32 MG/12.5 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN/HCTZ 32 MG/25 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 142

2 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-SEVELAMER 800 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 CAPLET ORL TAB TLI TAB ACETAMINOPHEN 325 MG TABLET ORL TAB VTH TAB ACETAMINOPHEN 325 MG TABLET ORL TAB WAM TAB ACETAMINOPHEN 325 MG TABLET ORL TAB TLI TAB ACETAMINOPHEN 325 MG TABLET ORL TAB JPC 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 VTH TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB PMT TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB WTR 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 160 MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 2 of 142

3 ACETAMINOPHENE 325 MG COMPRIME ORL TAB RIV TAB ACETAMINOPHENE 325 MG TABLET ORL TAB PDL TAB ACETAMINOPHENE 500 MG CAPLET ORL TAB RIV TAB ACETAMINOPHENE 500 MG COMPRIME ORL TAB RIV TAB ACETAMINOPHENE 500 MG TABLET ORL TAB PDL 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 ACH-ANASTROZOLE 1 MG TABLET ORL TAB AHI TAB ACH-CAPECITABINE 150 MG TABLET ORL TAB AHI TAB ACH-CAPECITABINE 500 MG TABLET ORL TAB AHI TAB ACH-MYCOPHENOLATE 250 MG CAPSULE ORL CAP AHI CAP ACID REDUCER 75 MG TABLET ORL TAB PMS TAB ACIDOPHILUS PROBIOTIC COMPLETE CAPSULE ORL CAP WNP CAP ACIDOPHILUS WITH BIFIDUS CAPSULE ORL CAP WNP CAP ACT ALENDRONATE 70 MG TABLET ORL TAB APH TAB ACT AMPHETAMINE XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT ANASTROZOLE 1 MG TABLET ORL TAB APH TAB ACT AZITHROMYCIN 250 MG TABLET ORL TAB APH TAB ACT BETAHISTINE 24 MG TABLET ORL TAB APH TAB ACT CABERGOLINE 0.5 MG TABLET ORL TAB APH TAB ACT CANDESARTAN 4 MG TABLET ORL TAB APH TAB ACT CLOMIPRAMINE 25 MG TABLET ORL TAB APH TAB ACT CLOMIPRAMINE 50 MG TABLET ORL TAB APH TAB ACT DEXTROAMPHETAMINE SR 10 MG SR CAPSULE ORL SRC APH CAP ACT DEXTROAMPHETAMINE SR 15 MG SR CAPSULE ORL SRC APH CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 3 of 142

4 ACT DICLO-MISO 50 MG/200 MCG ENTERIC-COATED TABLET ORL ECT APH TAB ACT DICLO-MISO 75 MG/200 MCG ENTERIC-COATED TABLET ORL ECT APH TAB ACT DONEPEZIL 10 MG TABLET ORL TAB APH TAB ACT DONEPEZIL 5 MG TABLET ORL TAB APH TAB ACT DONEPEZIL ODT 10 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB ACT DONEPEZIL ODT 5 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB ACT ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APH TAB ACT ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC APH TAB ACT EZETIMIBE 10 MG TABLET ORL TAB 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 IRBESARTAN 150 MG TABLET ORL TAB APH TAB ACT IRBESARTAN 300 MG TABLET ORL TAB APH TAB ACT IRBESARTAN 75 MG TABLET ORL TAB APH TAB ACT LOSARTAN/HCT 100 MG/25 MG TABLET ORL TAB APH TAB ACT LOSARTAN/HCT 50 MG/12.5 MG TABLET ORL TAB APH TAB ACT MELOXICAM 15 MG TABLET ORL TAB APH TAB ACT MELOXICAM 7.5 MG TABLET ORL TAB APH TAB ACT MEMANTINE 10 MG TABLET ORL TAB APH TAB ACT MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL APH ML ACT OLANZAPINE 20 MG TABLET ORL TAB APH TAB ACT OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB APH TAB ACT OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB 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 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT APH TAB ACT PAROXETINE 10 MG TABLET ORL TAB APH TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 4 of 142

5 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 PROGESTERONE INJECTION 50 MG/ML INJECTION INJ DEFAUL APH ML ACT PROPOFOL 10 MG/ML INJECTION INJ DEFAUL APH ML ACT RAMIPRIL 10 MG CAPSULE ORL CAP/TAB APH CAP ACT RAMIPRIL 2.5 MG CAPSULE ORL CAP/TAB APH CAP ACT SERTRALINE 100 MG CAPSULE ORL CAP APH CAP ACT SERTRALINE 25 MG CAPSULE ORL CAP APH CAP ACT SERTRALINE 50 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 SIMVASTATIN 10 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 20 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 40 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 5 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 80 MG TABLET ORL TAB APH TAB ACT SOLIFENACIN 10 MG TABLET ORL TAB APH TAB ACT SOLIFENACIN 5 MG TABLET ORL TAB APH TAB ACT SUMATRIPTAN 25 MG TABLET ORL TAB APH TAB ACT SUMATRIPTAN 50 MG TABLET ORL TAB APH TAB ACT TADALAFIL 10 MG TABLET ORL TAB APH TAB ACT TADALAFIL 2.5 MG TABLET ORL TAB APH TAB ACT TADALAFIL 20 MG TABLET ORL TAB APH TAB ACT TADALAFIL 5 MG TABLET ORL TAB APH TAB ACT TELMISARTAN/HCT 80 MG/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 5 of 142

6 ACT TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APH CAP ACT TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APH CAP ACT VALSARTAN 40 MG TABLET ORL TAB APH TAB ACT-ESCITALOPRAM ODT 10 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB ACT-ESCITALOPRAM ODT 20 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB ACTIKERALL 0.5 %/10 % TOPICAL SOLUTION TOP SOL CIP ML 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 30 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 PFI ML ACYCLOVIR SODIUM 50 MG/ML INJECTION INJ DEFAUL FKC 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 TB 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 Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 6 of 142

7 ADEMPAS 2.5 MG TABLET ORL TAB BAI TAB ADLYXINE 0.05 MG/ML PRE-FILLED PEN INJECTION INJ DEFAUL SAV ML ADLYXINE 0.1 MG/ML PRE-FILLED PEN INJECTION INJ DEFAUL SAV ML ADLYXINE STARTER KIT INJ DEFAUL SAV 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 ADVANCED B COMPLEX ORL CAP AOR CAP 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 AEROBIKA OSC POSITIVE EXPIRATORY PRESS THERAPY SYS DEFAUL DEV TMI DEV AEROCHAMBER AC GIRLZ CHAMBER DEFAUL DEV TMI DEV 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 7.5 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 AG-DONEPEZIL 10 MG TABLET ORL TAB AGP TAB AG-DONEPEZIL 5 MG TABLET ORL TAB AGP TAB AGRIFLU INJECTION SYRINGE INJ DEFAUL SEQ SYR AGRIFLU MULTI-DOSE VIAL INJECTION INJ DEFAUL SEQ ML AGRYLIN 0.5 MG CAPSULE ORL CAP SHB CAP AHI-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AHI TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 7 of 142

8 AHI-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AHI TAB AKYNZEO 0.5 MG/300 MG CAPSULE ORL CAP PUR CAP ALBALON 0.1% OPH SOLUTION OPH SOL ALL ML ALDACTAZIDE-25 TABLET ORL TAB PFI TAB ALDACTAZIDE-50 TABLET ORL TAB PFI TAB ALDACTONE 100 MG TABLET ORL TAB PFI TAB ALDACTONE 25 MG TABLET ORL TAB PFI TAB ALDURAZYME 0.58 MG/ML INJECTION INJ DEFAUL GZM ML ALECENSARO 150 MG CAPSULE ORL CAP HLR CAP ALENDRONATE SODIUM 5 MG TABLET ORL TAB AHI TAB ALENDRONATE MG TABLET ORL TAB PDL 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 APC TAB ALLEGRA 12 HOUR 60 MG TABLET ORL TAB SAV TAB ALLEGRA 24 HOUR 120 MG TABLET ORL TAB SAV TAB 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 ALLERGENIC EXTRACT POLLENS UNIT/ML INJ INJ DEFAUL ALK ML ALLERGY 25 MG TABLET ORL TAB TAN TAB ALLERGY DROPS 0.012% OPH SOLUTION OPH SOL BSH ML ALLERGY FORMULA 25 MG CAPLET ORL TAB PRI TAB ALLERGY RELIEF 10 MG TABLET ORL TAB APX TAB ALLERGY REMEDY 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 Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 8 of 142

9 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 NOV ML ALOXI 0.05 MG/ML INJECTION INJ DEFAUL PUR ML ALOXI 0.5 MG CAPSULE ORL CAP PUR 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 ALREX 0.2% OPHTHALMIC SUSPENSION OPH SUS BSH ML ALSOY INFANT FORMULA ORAL POWDER ORL PWR NHN G 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 AMETOP 4% TOPICAL GEL TOP GEL SNE G AMI-HYDRO 50 MG/5 MG TABLET ORL TAB PDL TAB AMIKACIN SULFATE 250 MG/ML INJECTION INJ DEFAUL SDZ ML AMIODARONE SYRINGE 50 MG/ML INJECTION INJ NDL SDZ SYR AMITRIPTYLINE 10 MG TABLET ORL TAB PDL TAB AMITRIPTYLINE 10 MG TABLET ORL TAB SIV TAB AMITRIPTYLINE 25 MG TABLET ORL TAB PDL TAB AMITRIPTYLINE 25 MG TABLET ORL TAB SIV TAB AMITRIPTYLINE 50 MG TABLET ORL TAB PDL TAB AMITRIPTYLINE 50 MG TABLET ORL TAB SIV TAB AMLODIPINE 10 MG TABLET ORL TAB PDL TAB AMLODIPINE 2.5 MG TABLET ORL TAB PDL TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 9 of 142

10 AMLODIPINE 5 MG TABLET ORL TAB PDL TAB AMOSAN 68.6% MOUTHWASH ORL MWH OLB ML AMOXICILLIN 25 MG/ML ORAL SUSPENSION ORL SUS SNS ML AMOXICILLIN SUGAR-REDUCED 25 MG/ML ORAL SUSPENSION ORL SUS SNS ML AMOXICILLIN SUGAR-REDUCED 50 MG/ML ORAL SUSPENSION ORL SUS SIV 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 AMPICILLIN 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL AMPICILLIN 2 G/VIAL INJECTION INJ DEFAUL FKC VIAL AMPICILLIN 250 MG/VIAL INJECTION INJ DEFAUL FKC VIAL AMPICILLIN 500 MG/VIAL INJECTION INJ DEFAUL FKC VIAL A-MULSION ORAL LIQUID ORL LIQ SRL ML ANANDRON 50 MG TABLET ORL TAB SAV TAB ANASTROZOLE 1 MG TABLET ORL TAB SNS TAB ANDRIOL 40 MG CAPSULE ORL CAP MFC CAP ANDROGEL (2.5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G ANDROGEL (5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G ANDROGEL (75 G/PUMP) 1% TOPICAL GEL TOP GEL BGP G ANGELIQ 1 MG/1 MG TABLET ORL TAB BAI TAB 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 ANTI-STATIC COMPACT SPACE CHAMBER PLUS MOUTHPIECE DEFAUL DEV MPI DEV ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ LG MASK DEFAUL ADUDEV MPI DEV ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ MED MASK DEFAUL PEDDEV MPI DEV ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ SM MASK DEFAUL INFDEV MPI DEV ANUSOL 0.5% RECTAL OINTMENT RT ONT MCL G ANUSOL 10 MG RECTAL SUPPOSITORY RT SUP MCL SUP ANUSOL PLUS RECTAL OINTMENT RT ONT MCL G ANUSOL PLUS RECTAL SUPPOSITORY RT SUP MCL SUP ANUZINC PLUS RECTAL OINTMENT RT ONT SDZ G AOR CHROMIUM PICOLINATE 600 MCG CAPSULE ORL CAP AOR CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 10 of 142

11 AOR N.A.C. 500 MG CAPSULE ORL CAP AOR CAP APO-ABACAVIR 300 MG TABLET ORL TAB APX TAB APO-ABACAVIR-LAMIVUDINE 600 MG/300 MG TABLET ORL TAB APX TAB APO-ABACAVIR-LAMIVUDINE-ZIDOVUDINE TABLET ORL TAB APX TAB APO-ACETAMINOPHEN 325 MG CAPLET ORL TAB APX TAB APO-ACETAMINOPHEN 325 MG TABLET ORL TAB APX TAB APO-ALENDRONATE 5 MG TABLET ORL TAB APX TAB APO-ALENDRONATE/VITAMIN D3 70 MG/2800 UNIT 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 25 MG/ML SUGAR FREE ORAL SUSPENSION ORL SUS APX ML APO-AMOXI 50 MG/ML SUGAR FREE ORAL SUSPENSION ORL SUS APX ML APO-AMOXI CLAV 25 MG/6.25 MG ORAL SUSPENSION ORL SUS APX ML APO-AMOXI CLAV 50 MG/12.5 MG ORAL SUSPENSION ORL SUS APX ML 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-ASA LD 81 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-BICALUTAMIDE 50 MG TABLET ORL TAB APX TAB APO-BOSENTAN 125 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 142

12 APO-BOSENTAN 62.5 MG TABLET ORL TAB APX TAB 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 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-CETIRIZINE 10 MG TABLET ORL TAB APX TAB APO-CETIRIZINE 20 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-CICLESONIDE 50 MCG/DOSE METERED DOSE NASAL SP NAS SPM APX DOSE APO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL APX G APO-CIMETIDINE 600 MG TABLET ORL TAB APX TAB APO-CINACALCET 30 MG TABLET ORL TAB APX TAB APO-CINACALCET 60 MG TABLET ORL TAB APX TAB APO-CINACALCET 90 MG TABLET ORL TAB APX TAB APO-CIPROFLOX 0.3% OPHTHALMIC SOLUTION OPH SOL APX ML APO-CLARITHROMYCIN 250 MG TABLET ORL TAB APX TAB APO-CLARITHROMYCIN 500 MG TABLET ORL TAB APX TAB APO-CLOMIPRAMINE 25 MG TABLET ORL TAB APX TAB APO-CLOMIPRAMINE 50 MG TABLET ORL TAB APX TAB APO-DESVENLAFAXINE 100 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-DESVENLAFAXINE 50 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-DICLO RAPIDE 50 MG TABLET ORL TAB APX TAB APO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL APX ML 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-EMTRICITABINE-TENOFOVIR 200 MG/300 MG TABLET ORL TAB APX TAB APO-ENTACAPONE 200 MG TABLET ORL TAB APX TAB APO-ERLOTINIB 100 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 12 of 142

13 APO-ERLOTINIB 150 MG TABLET ORL TAB APX TAB APO-ERLOTINIB 25 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/DRC 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-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 APO-GAIN 2% TOPICAL SOLUTION TOP SOL APX ML APO-GEFITINIB 250 MG TABLET ORL TAB 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-HYDROXYUREA 500 MG CAPSULE ORL CAP APX CAP 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-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 1000 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-METHYLPHENIDATE ER 18 MG EXTENDED REL. TABLET ORL ERT APX TAB APO-METHYLPHENIDATE ER 27 MG EXTENDED REL. TABLET ORL ERT APX TAB APO-METHYLPHENIDATE ER 36 MG EXTENDED REL. TABLET ORL ERT APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 13 of 142

14 APO-METHYLPHENIDATE ER 54 MG EXTENDED REL. TABLET ORL ERT APX TAB APO-MIRTAZAPINE 15 MG TABLET ORL TAB APX TAB APO-MIRTAZAPINE 45 MG TABLET ORL TAB APX TAB APO-MOXIFLOXACIN 0.5 % OPHTHALMIC SOLUTION OPH SOL APX ML 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-NALTREXONE 50 MG TABLET ORL TAB APX TAB APO-NAPROXEN EC 250 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-NARATRIPTAN 1 MG TABLET ORL TAB APX TAB APO-NARATRIPTAN 2.5 MG TABLET ORL TAB APX TAB APO-NEVIRAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-OLANZAPINE 20 MG TABLET ORL TAB APX TAB APO-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB APX TAB APO-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB APX TAB APO-OLOPATADINE 0.1% OPHTHALMIC 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-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 Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 14 of 142

15 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-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-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB APX CAP APO-RAMIPRIL/HCTZ 10 MG/12.5 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 10 MG/25 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 2.5 MG/12.5 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 5 MG/12.5 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 5 MG/25 MG TABLET ORL TAB APX TAB APO-RASAGILINE 0.5 MG TABLET ORL TAB APX TAB APO-RASAGILINE 1 MG TABLET ORL TAB APX TAB APO-RISEDRONATE 150 MG TABLET ORL TAB APX TAB APO-RISPERIDONE 1 MG/ML ORAL SOLUTION ORL SOL APX ML APO-ROPINIROLE 0.25 MG TABLET ORL TAB APX TAB APO-ROPINIROLE 2 MG TABLET ORL TAB APX TAB APO-ROPINIROLE 5 MG TABLET ORL TAB APX TAB 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-TADALAFIL 10 MG TABLET ORL TAB APX TAB APO-TADALAFIL 2.5 MG TABLET ORL TAB APX TAB APO-TADALAFIL 20 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 15 of 142

16 APO-TADALAFIL 5 MG TABLET ORL TAB APX TAB APO-TADALAFIL PAH 20 MG TABLET ORL TB 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-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-TOLTERODINE 1 MG TABLET ORL TAB APX TAB APO-TOLTERODINE 2 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-TRIAMCINOLONE AQ 55 MCG METERED DOSE SPRAY NAS SPM APX DOSE APO-VALSARTAN 40 MG TABLET ORL TAB APX TAB APO-VERAP SR 180 MG SUSTAINED-RELEASE TABLET ORL SRT APX TAB APO-ZIDOVUDINE 100 MG CAPSULE ORL CAP APX CAP APO-ZOLMITRIPTAN RAPID 2.5 MG ORALLY DISP. TABLET ORL DISPTAB APX TAB 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 APTIVUS 250 MG CAPSULE ORL CAP BOE CAP AQUASOL E 50 UNIT/ML ORAL DROPS ORL DPS NOV ML AREDIA 30 MG/VIAL INJECTION INJ DEFAUL NOV ML AREDIA 90 MG/VIAL INJECTION INJ DEFAUL 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 Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 16 of 142

17 ARLIDIN 6 MG TABLET ORL TAB ERF TAB ARNICA 7% GEL TOP GEL BCI G ARNICA GEL-CREAM RUB A535 TOPICAL GEL TOP GEL CHD G ARNICARE TOPICAL GEL TOP GEL BCI 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 NOV VIAL ARZERRA 1000 MG/50 ML VIAL INJECTION INJ DEFAUL NOV VIAL ASA & CODEINE 8 MG TABLET ORL TAB SDR TAB ASA 325 MG TABLET ORL TAB WAM TAB ASA 325 MG TABLET ORL TAB TEV TAB ASA 325 MG TABLET ORL TAB VTH TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT VTH TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASA EC 80 MG TABLET ORL TAB SNS 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 ASPIRIN 325 MG TABLET ORL TAB BAI TAB ASPIRIN 81 MG QUICK CHEWS CHEWABLE TABLET ORL CTB BIC TAB ASPIRIN STOMACH GUARD EXTRA STRENGTH 500 MG CAPLET ORL TAB BIC TAB ATACAND 4 MG TABLET ORL TAB AZC TAB ATASOL FORTE 500 MG TABLET ORL TAB CHD TAB ATASOL-15 TABLET ORL TAB CHD TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 17 of 142

18 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 10 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 10 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 100 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 18 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 18 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 18 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 25 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 25 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 25 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 40 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 40 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 40 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 60 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 60 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 60 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 80 MG CAPSULE ORL CAP SNS CAP ATORVASTATIN 10 MG TABLET ORL TAB PDL TAB ATORVASTATIN 10 MG TABLET ORL TAB SIV 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 SIV TAB ATORVASTATIN 80 MG TABLET ORL TAB PDL TAB ATORVASTATIN 80 MG TABLET ORL TAB SIV TAB ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB SNS TAB ATRIANCE 5 MG/ML INJECTION INJ DEFAUL NOV ML ATRIPLA TABLET ORL TAB BMG TAB ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL TGT ML Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 18 of 142

19 ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL ALV ML ATROPINE 0.6 MG/ML INJECTION INJ DEFAUL ALV ML ATROPINE 0.6 MG/ML INJECTION BP INJ DEFAUL TGT ML ATROPINE SULFATE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML ATROVENT 0.06% NASAL SPRAY NAS SPR BOE ML AURALGAN OTIC SOLUTION OT SOL PAL ML AURO-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB AUR TAB AURO-BETAHISTINE 24 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN 16 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN 32 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN 4 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN 8 MG TABLET ORL TAB AUR TAB AURO-CEFIXIME 100 MG/5 ML ORAL SUSPENSION ORL SUS AUR ML AURO-CEFPROZIL 250 MG TABLET ORL TAB AUR TAB AURO-CEFPROZIL 500 MG TABLET ORL TAB AUR TAB AURO-CIPROFLOXACIN 750 MG TABLET ORL TAB AUR TAB AURO-EFAVIRENZ 600 MG TABLET ORL TAB AUR TAB AURO-FINASTERIDE 1 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-LEVOFLOXACIN 250 MG TABLET ORL TAB AUR TAB AURO-LEVOFLOXACIN 500 MG TABLET ORL TAB AUR TAB AURO-LEVOFLOXACIN 750 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-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-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AUR TAB AURO-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AUR TAB AURO-NEVIRAPINE 200 MG TABLET ORL TAB AUR TAB AURO-NITROFURANTOIN 100 MG CAPSULE ORL CAPMMC AUR CAP AURO-OLANZAPINE ODT 15 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB AURO-OLANZAPINE ODT 20 MG ORALLY DISINT. TABLET ORL DISNTAB AUR TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 19 of 142

20 AURO-OMEPRAZOLE 10 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT AUR CAP AURO-PAROXETINE 10 MG TABLET ORL TAB AUR TAB 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 0.5 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-RISEDRONATE 150 MG TABLET ORL TAB AUR TAB AURO-TADALAFIL 10 MG TABLET ORL TAB AUR TAB AURO-TADALAFIL 2.5 MG TABLET ORL TAB AUR TAB AURO-TADALAFIL 20 MG TABLET ORL TAB AUR TAB AURO-TADALAFIL 5 MG TABLET ORL TAB AUR TAB AURO-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB AUR TAB AURO-VALSARTAN 40 MG TABLET ORL TAB AUR TAB AVAMYS 27.5 MCG/DOSE NASAL SPRAY NAS SPM GSK DOSE AVANDAMET 2 MG/1000 MG TABLET ORL TAB GSK TAB AVANDAMET 2 MG/500 MG TABLET ORL TAB GSK TAB AVANDAMET 4 MG/500 MG TABLET ORL TAB GSK TAB AVASTIN 25 MG/ML INJECTION INJ DEFAUL HLR ML AVA-TOPIRAMATE 200 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 AVEENO CREAM TOP CRM JJI G AVEENO MOISTURIZING BATH TOP PWR JJI G AXERT 12.5 MG TABLET ORL TAB MCL TAB AXERT 6.25 MG TABLET ORL TAB MCL TAB AXIRON 2% TOPICAL SOLUTION TOP SOL LIL ML AZILECT 0.5 MG TABLET ORL TAB TMP TAB AZILECT 1 MG TABLET ORL TAB TMP TAB B COMPLEX 50 TABLET ORL TAB JAM TAB B COMPLEX 75 TABLET ORL TAB JAM TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 20 of 142

21 B COMPLEX PLUS C TABLET ORL TAB JAM TAB B COMPLEX VITAMINS WITH VITAMIN C TABLET ORL TAB PMT TAB B&C VITAMINS TABLET ORL TAB WBP TAB B MCG TABLET ORL TAB WNP TAB B50 COMPLEX CAPSULE ORL CAP WNP CAP B50 COMPLEX WITH LIPOTROPIC FACTORS TABLET ORL TAB PMT TAB BABY DDROPS 400IU/DROP ORAL LIQUID ORL DPS DDR ML 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 BACKUP PLAN ONESTEP 1.5 MG TABLET ORL TAB APX TAB BACLOFEN 10 MG TABLET ORL TAB PDL TAB BACLOFEN 20 MG TABLET ORL TAB PDL TAB BACTERIOSTATIC SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL PFI ML BACTROBAN 2% TOPICAL CREAM TOP CRM GKC G BACTROBAN 2% TOPICAL OINTMENT TOP ONT GKC G BALANCED B COMPLEX 100 MG SUSTAINED-RELEASE TABLET ORL SRT PMT TAB BALMINIL DM 3 MG/ML ORAL SYRUP ORL SYR ROG ML BALNETAR 2.5% TOPICAL SOLUTION TOP SOL WSD ML BANATROL PLUS ORAL POWDER FOR SOLUTION ORL PWR MDT G BARRIERE 20% TOPICAL CREAM TOP CRM WSP G BASAGLAR 80 UNIT/INJECTION KWIKPEN INJ DEFAUL LIL ML BASALJEL 500 MG CAPSULE ORL CAP AUP CAP BAXEDIN 20% SOLUTION TOP SOL OMG ML BAZA CLEANSE & PROTECT 2% TOPICAL LOTION TOP LOT COC ML BAZA PROTECT 2 TOPICAL CREAM TOP CRM COC G 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 MCL ML BENADRYL 2% TOPICAL CREAM TOP CRM MCL G BENADRYL 25 MG CAPLET ORL TAB MCL TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 21 of 142