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1 Acyclovir Capsules 200mg Viruses Albuterol Syrup 2mg/5ml Asthma Albuterol Sulfate Solution 0.05% * Asthma Albuterol Sulfate Solution 0.083% Asthma Alendronate Tablets 35mg Other Medical Conditions Alendronate Tablets 70mg Other Medical Conditions Allopurinol Tablets 100mg Arthritis & Pain Allopurinol Tablets 300mg Arthritis & Pain Amitriptyline Tablets 10mg Mental Health Amitriptyline Tablets 25mg Mental Health Amitriptyline Tablets 50mg Mental Health Amitriptyline Tablets 75mg Mental Health Amitriptyline Tablets 100mg Mental Health Amlodipine Tablets 2.5mg Heart Health & Blood Pressure Amlodipine Tablets 5mg Heart Health & Blood Pressure Amlodipine Tablets 10mg Heart Health & Blood Pressure Amoxicillin Suspension 125mg/5ml * Antibiotic Treatment Amoxicillin Suspension 125mg/5ml * Antibiotic Treatment Amoxicillin Suspension 125mg/5ml * Antibiotic Treatment Amoxicillin Suspension 200mg/5ml * Antibiotic Treatment Amoxicillin Suspension 200mg/5ml * Antibiotic Treatment Amoxicillin Suspension 200mg/5ml * Antibiotic Treatment Amoxicillin Suspension 250mg/5ml * Antibiotic Treatment Amoxicillin Suspension 250mg/5ml * Antibiotic Treatment Amoxicillin Suspension 250mg/5ml * Antibiotic Treatment Amoxicillin Suspension 400mg/5ml * Antibiotic Treatment Amoxicillin Suspension 400mg/5ml * Antibiotic Treatment Amoxicillin Suspension 400mg/5ml * Antibiotic Treatment Amoxicillin Capsules 250mg Antibiotic Treatment Amoxicillin Capsules 500mg Antibiotic Treatment Atenolol Tablets 25mg Heart Health & Blood Pressure Atenolol Tablets 50mg Heart Health & Blood Pressure Atenolol Tablets 100mg Heart Health & Blood Pressure Atenolol/Chlortal Tablets 50mg/25mg Heart Health & Blood Pressure Atenolol/Chlortal Tablets 100mg/25mg Heart Health & Blood Pressure Baclofen Tablets 10mg Arthritis & Pain Baclofen Tablets 20mg Arthritis & Pain Benazepril Tablets 5mg Heart Health & Blood Pressure Benazepril Tablets 10mg Heart Health & Blood Pressure Benazepril Tablets 20mg Heart Health & Blood Pressure Benazepril Tablets 40mg Heart Health & Blood Pressure Benzonatate Capsules 100mg Allergies, Cold & Flu Benztropine Tablets.5mg Mental Health Benztropine Tablets 1mg Mental Health Benztropine Tablets 2mg Mental Health Bisoprolol/HCTZ Tablets 2.5mg/6.25 Heart Health & Blood Pressure Bisoprolol/HCTZ Tablets 5mg/6.25mg Heart Health & Blood Pressure Bisoprolol/HCTZ Tablets 10mg/6.25mg Heart Health & Blood Pressure Bumetanide Tablets.5mg Heart Health & Blood Pressure Bumetanide Tablets 1mg Heart Health & Blood Pressure Buspirone Tablets 5mg Mental Health Buspirone Tablets 10mg Mental Health Buspirone Tablets 15mg Mental Health Captopril Tablets 12.5mg Heart Health & Blood Pressure Captopril Tablets 25mg Heart Health & Blood Pressure Captopril Tablets 50mg Heart Health & Blood Pressure Captopril Tablets 100mg Heart Health & Blood Pressure Carbamazepine * Prepackaged Tablets drugs are covered only in unit sizes specified 200mg on drug list. This list is subject Mental to change Health without notice Page 1 of 6

2 Carvedilol Tablets 3.125mg Heart Health & Blood Pressure Carvedilol Tablets 6.25mg Heart Health & Blood Pressure Carvedilol Tablets 12.5mg Heart Health & Blood Pressure Carvedilol Tablets 25mg Heart Health & Blood Pressure Cephalexin Capsules 250mg Antibiotic Treatment Cephalexin Capsules 500mg Antibiotic Treatment Chlorhexidine Gluconate Liquid 0.12% Other Medical Conditions Cimetidine Tablets 300mg Gastrointestinal Health Cimetidine Tablets 400mg Gastrointestinal Health Cimetidine Tablets 800mg Gastrointestinal Health Ciprofloxin Tablets 250mg Antibiotic Treatment Ciprofloxin Tablets 500mg Antibiotic Treatment Citalopram Tablets 10mg Mental Health Citalopram Tablets 20mg Mental Health Citalopram Tablets 40mg Mental Health Clindamycin Capsules 150mg Antibiotic Treatment Clomiphene Tablets 50mg Women's Health Clonidine Tablets.1mg Heart Health & Blood Pressure Clonidine Tablets.2mg Heart Health & Blood Pressure Clonidine Tablets.3mg Heart Health & Blood Pressure Cyclobenzaprine Tablets 5mg Arthritis & Pain Cyclobenzaprine Tablets 10mg Arthritis & Pain Cytra2 Solution Gastrointestinal Health Dexamethasone Tablets.5mg Arthritis & Pain Dexamethasone Tablets 0.75mg Arthritis & Pain Dexamethasone Tablets 4mg Arthritis & Pain 6 18 Diclofenac DR 75mg Arthritis & Pain Dicyclomine Tablets 10mg Gastrointestinal Health Dicyclomine Tablets 20mg Gastrointestinal Health Digoxin Tablets.125mg Heart Health & Blood Pressure Digoxin Tablets.25mg Heart Health & Blood Pressure Diltiazem HCl Tablets 30mg Heart Health & Blood Pressure Diltiazem HCl Tablets 60mg Heart Health & Blood Pressure Diltiazem HCl Tablets 90mg Heart Health & Blood Pressure Diltiazem HCl Tablets 120mg Heart Health & Blood Pressure Diphen/Atrop Tablets 2.5mg Gastrointestinal Health Diphenhydramine Capsules 50mg Allergies, Cold & Flu Doxepin Capsules 10mg Mental Health Doxepin Capsules 25mg Mental Health Doxepin Capsules 50mg Mental Health Enalapril Tablets 2.5mg Heart Health & Blood Pressure Enalapril Tablets 5mg Heart Health & Blood Pressure Enalapril Tablets 10mg Heart Health & Blood Pressure Enalapril Tablets 20mg Heart Health & Blood Pressure Enalapril/HCTZ Tablets 5mg/12.5mg Heart Health & Blood Pressure Estradiol Tablets.5mg Women's Health Estradiol Tablets 1mg Women's Health Estradiol Tablets 2mg Women's Health Famotidine Tablets 20mg Gastrointestinal Health Famotidine Tablets 40mg Gastrointestinal Health Ferrous Sulfate Tablets - Red 325mg Vitamins & Supplements Finasteride Tablets 5mg Men's Health Fluconazole Tablets 100mg Fungal Infections Fluconazole Tablets 150mg Fungal Infections 1 3 Fluconazole Tablets 200mg Fungal Infections Fluoxetine Capsules 10mg Mental Health Fluoxetine Tablets 10mg Mental Health Page 2 of 6

3 Fluoxetine Capsules 20mg Mental Health Fluoxetine Capsules 40mg Mental Health Fluphenazine Tablets 1mg Mental Health Fluphenazine Tablets 2.5mg Mental Health Folic Acid Tablets 1mg Vitamins & Supplements Furosemide Tablets 20mg Heart Health & Blood Pressure Furosemide Tablets 40mg Heart Health & Blood Pressure Furosemide Tablets 80mg Heart Health & Blood Pressure Gabapentin Capsules 100mg Mental Health Gentamycin Cream 1% * Skin Conditions Gentamycin Ointment 1% * Skin Conditions Glimepiride Tablets 1mg Diabetes Glimepiride Tablets 2mg Diabetes Glimepiride Tablets 4mg Diabetes Glipizide Tablets 5mg Diabetes Glipizide Tablets 10mg Diabetes Glipizide ER Tablets 5mg Diabetes Glyburide Tablets 2.5mg Diabetes Glyburide Tablets 5mg Diabetes Glyburide Micronized Tablets 1.5mg Diabetes Glyburide Micronized Tablets 3mg Diabetes Glyburide Micronized Tablets 6mg Diabetes Guanfacine Tablets 1mg Heart Health & Blood Pressure Haloperidol Tablets.5mg Mental Health Haloperidol Tablets 1mg Mental Health Haloperidol Tablets 2mg Mental Health Haloperidol Tablets 5mg Mental Health Hydralazine Tablets 10mg Heart Health & Blood Pressure Hydralazine Tablets 25mg Heart Health & Blood Pressure Hydrochlorothiazide Capsules 12.5mg Heart Health & Blood Pressure Hydrochlorothiazide Tablets 25mg Heart Health & Blood Pressure Hydrochlorothiazide Tablets 50mg Heart Health & Blood Pressure Hydrocortisone Cream 1% * Skin Conditions Hydrocortisone Cream 2.5% * Skin Conditions Hydroxyzine Pamoate Capsules 25mg Mental Health Hydroxyzine Pamoate Capsules 50mg Mental Health Ibuprofen Suspension 100mg/5ml Arthritis & Pain Ibuprofen Tablets 400mg Arthritis & Pain Ibuprofen Tablets 600mg Arthritis & Pain Ibuprofen Tablets 800mg Arthritis & Pain Indapamide Tablets 1.25mg Heart Health & Blood Pressure Indapamide Tablets 2.5mg Heart Health & Blood Pressure Indomethacin Capsules 25mg Arthritis & Pain Ipratropium Bromide Ampules 0.02% Asthma Isoniazid Tablets 300mg Other Medical Conditions Isosorbide Mononitrate ER Tablets 30mg Heart Health & Blood Pressure Isosorbide Mononitrate ER Tablets 60mg Heart Health & Blood Pressure Lactulose Solution 10gm/15ml Gastrointestinal Health Levothyroxine Tablets.1mg Thyroid Conditions Lidocaine Viscous Solution 2% Other Medical Conditions Lisinopril Tablets 2.5mg Heart Health & Blood Pressure Lisinopril Tablets 5mg Heart Health & Blood Pressure Lisinopril Tablets 10mg Heart Health & Blood Pressure Lisinopril Tablets 20mg Heart Health & Blood Pressure Lisinopril Tablets 30mg Heart Health & Blood Pressure Lisinopril Tablets 40mg Heart Health & Blood Pressure Lisinopril/HCTZ Tablets 10/12.5mg Heart Health & Blood Pressure Page 3 of 6

4 Lisinopril/HCTZ Tablets 20/12.5mg Heart Health & Blood Pressure Lisinopril/HCTZ Tablets 20/25mg Heart Health & Blood Pressure Lithium Carbonate Capsules 300mg Mental Health Loperamide Capsules 2mg Gastrointestinal Health Loratadine Tablets 10mg Allergies, Cold & Flu Losartan Tablets 25mg Heart Health & Blood Pressure Losartan Tablets 50mg Heart Health & Blood Pressure Losartan/HCTZ Tablets 50/12.5 Heart Health & Blood Pressure Losartan/HCTZ Tablets 100/12.5 Heart Health & Blood Pressure Losartan/HCTZ Tablets 100/25 Heart Health & Blood Pressure Lovastatin Tablets 10mg Cholesterol Lovastatin Tablets 20mg Cholesterol Lovastatin Tablets 40mg Cholesterol Mag Oxide Tablets 400mg Vitamins & Supplements Mag SR Tablets 64mg Vitamins & Supplements Medroxyprogesterone Tablets 2.5mg Women's Health Medroxyprogesterone Tablets 5mg Women's Health Medroxyprogesterone Tablets 10mg Women's Health Megestrol Tablets 20mg Other Medical Conditions Meloxicam Tablets 7.5mg Arthritis & Pain Meloxicam Tablets 15mg Arthritis & Pain Metformin Tablets 500mg Diabetes Metformin Tablets 850mg Diabetes Metformin Tablets 1000mg Diabetes Metformin ER Tablets 500mg Diabetes Methyldopa Tablets 250mg Heart Health & Blood Pressure Methyldopa Tablets 500mg Heart Health & Blood Pressure Metoclopramide Solution 5mg/5ml Gastrointestinal Health Metoclopramide Tablets 5mg Gastrointestinal Health Metoclopramide Tablets 10mg Gastrointestinal Health Metoprolol Tartrate Tablets 25mg Heart Health & Blood Pressure Metoprolol Tartrate Tablets 50mg Heart Health & Blood Pressure Metoprolol Tartrate Tablets 100mg Heart Health & Blood Pressure Naproxen Tablets 250mg Arthritis & Pain Naproxen Tablets 375mg Arthritis & Pain Naproxen Tablets 500mg Arthritis & Pain Naproxen Sodium Tablets 550mg Arthritis & Pain Nortriptyline Capsules 10mg Mental Health Nortriptyline Capsules 25mg Mental Health Nortriptyline Capsules 50mg Mental Health Nortriptyline Capsules 75mg Mental Health Ondansetron Tablets 4mg Gastrointestinal Health Ondansetron Tablets 8mg Gastrointestinal Health Paroxetine Tablets 10mg Mental Health Paroxetine Tablets 20mg Mental Health Paroxetine Tablets 30mg Mental Health Paroxetine Tablets 40mg Mental Health Penicillin VK Suspension 125mg/5ml * Antibiotic Treatment Penicillin VK Suspension 125mg/5ml * Antibiotic Treatment Penicillin VK Suspension 250mg/5ml * Antibiotic Treatment Penicillin VK Tablets 250mg Antibiotic Treatment Phenazopyridine Tablets 100mg Other Medical Conditions 6 18 Phenazopyridine Tablets 200mg Other Medical Conditions Polymyxin/Trimeth Opth Susp 10mu-.01% Eye, Ear, Nose & Throat Potassium Chloride Liquid 10% Vitamins & Supplements Prazosin Capsules 1mg Heart Health & Blood Pressure Prazosin Capsules 2mg Heart Health & Blood Pressure Page 4 of 6

5 Prednisone Tablets 1mg Other Medical Conditions Prednisone Tablets 2.5mg Other Medical Conditions Prednisone Tablets 5mg Other Medical Conditions Prednisone Tablets 10mg Other Medical Conditions Prednisone Tablets 20mg Other Medical Conditions Prenatal Plus Tablets Vitamins & Supplements Prochlorperazine Tablets 5mg Mental Health Prochlorperazine Tablets 10mg Mental Health Promethazine Tablets 25mg Gastrointestinal Health Promethazine Syrup 6.25mg/5ml Gastrointestinal Health Promethazine DM Syrup mg/5ml Allergies, Cold & Flu Propranolol Tablets 10mg Heart Health & Blood Pressure Propranolol Tablets 20mg Heart Health & Blood Pressure Propranolol Tablets 40mg Heart Health & Blood Pressure Propranolol Tablets 80mg Heart Health & Blood Pressure Ranitidine Tablets 150mg Gastrointestinal Health Ranitidine Tablets 300mg Gastrointestinal Health Sertraline Tablets 25mg Mental Health Sertraline Tablets 50mg Mental Health Sertraline Tablets 100mg Mental Health Silver Sulfadiazine Cream 1% Skin Conditions Simvastatin Tablets 5mg Cholesterol Simvastatin Tablets 10mg Cholesterol Simvastatin Tablets 20mg Cholesterol Simvastatin Tablets 40mg Cholesterol Simvastatin Tablets 80mg Cholesterol Sodium Fluoride Tablets.25mg Vitamins & Supplements Sodium Fluoride Tablets.5mg Vitamins & Supplements Sodium Fluoride Tablets 1mg Vitamins & Supplements Sotalol Tablets 80mg Heart Health & Blood Pressure Spironolactone Tablets 25mg Heart Health & Blood Pressure Sulfameth/Trimeth Suspension /5ml Antibiotic Treatment Sulfameth/Trimeth Tablets 400/80mg Antibiotic Treatment Sulfameth/Trimeth Tablets 800/160mg Antibiotic Treatment Tamoxifen Tablets 10mg Women's Health Tamoxifen Tablets 20mg Women's Health Terazosin Capsules 1mg Heart Health & Blood Pressure Terazosin Capsules 2mg Heart Health & Blood Pressure Terazosin Capsules 5mg Heart Health & Blood Pressure Terazosin Capsules 10mg Heart Health & Blood Pressure Terbinafine Tablets 250mg Fungal Infections Thiothixene Capsules 2mg Mental Health Timolol Opth Drops 0.25% Eye, Ear, Nose & Throat 5 15 Timolol Opth Drops 0.5% Eye, Ear, Nose & Throat 5 15 Tobramycin Oth Drops 0.3% Eye, Ear, Nose & Throat 5 15 Topiramate Tablets 25mg Mental Health Topiramate Tablets 50mg Mental Health Tramadol Tablets 50mg Arthritis & Pain Trazodone Tablets 50mg Mental Health Trazodone Tablets 100mg Mental Health Trazodone Tablets 150mg Mental Health Triamcinolone Cream 0.025% * Skin Conditions Triamcinolone Cream 0.025% * Skin Conditions Triamcinolone Cream 0.1% * Skin Conditions Triamcinolone Cream 0.1% * Skin Conditions Triamcinolone Ointment 0.1% * Skin Conditions Triamcinolone Ointment 0.1% * Skin Conditions Page 5 of 6

6 Triamcinolone Cream 0.5% * Skin Conditions Triamterene/HCTZ Tablets 37.5/25mg Heart Health & Blood Pressure Triamterene/HCTZ Tablets 75mg/50mg Heart Health & Blood Pressure Trihexyphenidyl Tablets 2mg Mental Health Verapamil Tablets 80mg Heart Health & Blood Pressure Verapamil Tablets 120mg Heart Health & Blood Pressure Warfarin Tablets 1mg Heart Health & Blood Pressure Warfarin Tablets 2mg Heart Health & Blood Pressure Warfarin Tablets 2.5mg Heart Health & Blood Pressure Warfarin Tablets 3mg Heart Health & Blood Pressure Warfarin Tablets 4mg Heart Health & Blood Pressure Warfarin Tablets 5mg Heart Health & Blood Pressure Warfarin Tablets 6mg Heart Health & Blood Pressure Warfarin Tablets 7.5mg Heart Health & Blood Pressure Warfarin Tablets 10mg Heart Health & Blood Pressure Page 6 of 6

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