calcium chloride 100 mg/ml (10 %) intravenous solution,calcium chloride 100 mg/ml (10 %) $ 60.00

Px Code Generic Name CPT(R)/ HCPCS NDC Unit Price 2500000200 insulin human U-100 NPH-regulr 70-30 mix 100 J1815 00002871517 $ 223.05 2500000200 labetalol 5 mg/ml intravenous solution 00409226720 $ 60.00 2500000200 lidocaine 1 %-epinephrine 1:100,000 injection 63323048226 $ 5.75 2500000200 mepivacaine (PF) 15 mg/ml (1.5 %) injection J0670 00409104130 $ 70.00 2500000200 bupivacaine-epinephrine (PF) 0.5 %-1:200,000 00409904501 $ 10.95 2500000200 bupivacaine (PF) 0.5 % (5 mg/ml) injection 63323046631 $ 29.64 2500000200 bupivacaine (PF) 0.5 % (5 mg/ml) injection 00409116219 $ 8.45 2500000200 balanced salt solution non-surgical no.3 eye wash 00065053001 $ 109.80 2500000200 sodium borate-boric acid-sodium chloride-water 00904537720 $ 60.00 2500000200 cefazolin 2 gram/50 ml in dextrose (iso-osmotic) J0690 00264310511 $ 70.00 2500000200 sodium chloride 0.9 % irrigation solution 00264220100 $ 60.00 2500000200 sodium chloride 0.9 % irrigation solution 00338004802 $ 80.00 2500000200 vecuronium bromide 10 mg intravenous solution 67457043810 $ 80.00 2500000200 vecuronium bromide 20 mg intravenous solution 67457047520 $ 80.00 2500000200 water for injection, sterile injection solution 00409488750 $ 60.00 2500000200 water for injection, sterile injection solution 00409488723 $ 60.00 2500000200 zidovudine 100 mg capsule 65862010701 $ 7.00 2500000200 lidocaine 2 % mucosal solution 50383077504 $ 7.62 2500000200 bupivacaine (PF) 0.25 % (2.5 mg/ml) injection 55150016830 $ 8.18 2500000200 famotidine (PF) 20 mg/2 ml intravenous solution S0028 63323073916 $ 60.00 2500000200 vasopressin 20 unit/ml intravenous solution 42023016401 $ 501.74 2500000200 norepinephrine bitartrate 1 mg/ml intravenous 00703115303 $ 108.12 2500000200 lidocaine 2 % mucosal jelly in applicator 76329301305 $ 60.00 2500000200 calcium chloride 100 mg/ml (10 %) intravenous 00409163110 $ 70.00 2500000200 mvi,adult no.4 with vit K 3300 unit-150 mcg/10 54643786201 $ 121.38 2500000200 sugammadex 100 mg/ml intravenous solution 00006542312 $ 380.00 2500000200 bacitracin zinc 500 unit/gram topical ointment 67777022007 $ 68.00 2500000200 sodium hypochlorite 0.25 % solution 39328006325 $ 5.75 2500000200 sodium nitroprusside 25 mg/ml intravenous 00187430202 $ 690.00 2500000200 sodium nitroprusside 25 mg/ml intravenous 67457083902 $ 600.00 2500000200 cyclopentolate 1 % eye drops 17478010002 $ 47.28 2500000200 cyclopentolate 1 % eye drops 24208073501 $ 48.40 2500000200 etomidate 2 mg/ml intravenous solution 00409669502 $ 70.00 2500000200 etomidate 2 mg/ml intravenous solution 55150022220 $ 70.00 2500000200 diazepam 5 mg/ml injection solution J3360 00409321312 $ 182.40 2500000200 ondansetron 4 mg disintegrating tablet 68462015740 $ 5.75 2500000200 insulin glargine (U-100) 100 unit/ml J1815 00088222033 $ 600.00 2500000200 folic acid 5 mg/ml injection solution 63323018410 $ 60.00 2500000200 flumazenil 0.1 mg/ml intravenous solution 63323042405 $ 70.00 2500000200 diphenhydramine 25 mg 00904555159 $ 5.75 2500000200 calcium chloride 100 mg/ml (10 %) intravenous solution,calcium chloride 100 mg/ml (10 %) 00409163110 $ 60.00 2500000200 metoprolol tartrate 5 mg/5 ml intravenous solution,metoprolol tartrate 5 mg/5 ml 00143987325 $ 60.00 2500000200 mg/ml intravenous cartridge,morphine 4 mg/ml intravenous solution,morphine 4 mg/ml injection solution,morphine 4 mg/ml intravenous syringe J2270 00641612525 $ 60.00 2500000200 9999999021 $ 15.59 2500000200 9999999027 $ 14.94 2500000200 sodium chloride 0.9 % injection solution 63323018620 $ 60.00

2500000200 ketamine 10 mg/ml injection solution 42023011310 $ 108.00 2500000200 ketamine 50 mg/ml injection solution 00143950801 $ 60.00 2500000200 lidocaine 10 mg/ml (1 %) injection solution 63323048526 $ 5.75 2500000200 mannitol 20 % intravenous solution 00338035703 $ 60.00 2500000200 nafcillin 2 gram solution for injection S0032 63323032820 $ 173.35 2500000200 phenylephrine 2.5 % eye drops 17478020115 $ 315.00 2500000200 prochlorperazine maleate 5 mg tablet 00378510501 $ 5.75 2500000200 promethazine 25 mg tablet 65162052110 $ 5.75 2500000200 sodium bicarbonate 8.4 % (1 meq/ml) 00409663734 $ 80.00 2500000200 sodium bicarbonate 8.4 % (1 meq/ml) 76329335201 $ 80.00 2500000200 sodium chloride 0.9 % injection syringe 63807010001 $ 5.75 2500000200 sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) 60267070550 $ 400.00 2500000200 water for irrigation, sterile solution 00338000402 $ 70.00 2500000200 water for irrigation, sterile solution 00338000404 $ 60.00 2500000200 clindamycin 150 mg/ml injection solution 00009030225 $ 70.00 2500000200 clindamycin 150 mg/ml injection solution 67457081402 $ 70.00 2500000200 tuberculin PPD 5 tub. unit/0.1 ml intradermal 42023010401 $ 70.00 2500000200 tuberculin PPD 5 tub. unit/0.1 ml intradermal 09999020101 $ 70.00 2500000200 verapamil 2.5 mg/ml intravenous solution 00409114401 $ 60.00 2500000200 verapamil 2.5 mg/ml intravenous solution 00409401101 $ 70.00 2500000200 verapamil 2.5 mg/ml intravenous solution 00409114402 $ 70.00 2500000200 aztreonam 1 gram solution for injection S0073 63323040120 $ 164.75 2500000200 ceftriaxone 1 gram/50 ml in dextrose (iso- J0696 00264315311 $ 80.00 2500000200 ceftriaxone 2 gram/50 ml in dextrose (iso-osm) J0696 00264315511 $ 109.38 2500000200 diltiazem 5 mg/ml intravenous solution 17478093710 $ 60.00 2500000200 diltiazem 5 mg/ml intravenous solution 17478081705 $ 60.00 2500000200 diltiazem 5 mg/ml intravenous solution 17478081725 $ 80.00 2500000200 diltiazem 5 mg/ml intravenous solution 17478093726 $ 80.00 2500000200 dronabinol 2.5 mg capsule 49884086702 $ 21.76 2500000200 dronabinol 2.5 mg capsule 67877056860 $ 9.12 2500000200 enalaprilat 1.25 mg/ml intravenous solution 00143978610 $ 70.00 6360000200 fluconazole 200 mg/100 ml in sod. chloride (iso) J1450 36000000210 $ 70.00 6360000200 heparin (porcine) 1,000 unit/ml injection solution J1644 25021040067 $ 60.00 6360000200 heparin (porcine) 10,000 unit/ml injection J1644 25021040366 $ 60.00 6360000200 pneumococcal 13-val conj vaccine-dip crm (PF) 90670 00005197105 $ 554.76 6360000200 lidocaine (PF) 10 mg/ml (1 %) injection solution J2001 00409471302 $ 7.07 6360000200 lidocaine (PF) 10 mg/ml (1 %) injection solution J2001 63323049257 $ 15.66 6360000200 lidocaine (PF) 20 mg/ml (2 %) injection solution J2001 63323049507 $ 13.17 6360000200 lidocaine (PF) 20 mg/ml (2 %) injection solution J2001 00409206610 $ 11.32 6360000200 measles,mumps,rubella vaccine live(pf)1,000-90707 00006468100 $ 291.16 6360000200 denosumab 60 mg/ml subcutaneous syringe J0897 55513071001 $ 2,367.10 6360000200 methylergonovine 0.2 mg/ml (1 ml) injection J2210 51991014499 $ 118.56 6360000200 enoxaparin 30 mg/0.3 ml subcutaneous syringe J1650 00955100310 $ 133.82 6360000200 enoxaparin 40 mg/0.4 ml subcutaneous syringe J1650 00955100410 $ 150.00 6360000200 enoxaparin 40 mg/0.4 ml subcutaneous syringe J1650 00075801410 $ 165.38 6360000200 enoxaparin 60 mg/0.6 ml subcutaneous syringe J1650 00955100610 $ 223.28 6360000200 enoxaparin 60 mg/0.6 ml subcutaneous syringe J1650 00075062160 $ 248.36 6360000200 enoxaparin 100 mg/ml subcutaneous syringe J1650 00955101010 $ 297.70 6360000200 ondansetron HCl (PF) 4 mg/2 ml injection J2405 00641607825 $ 60.00 6360000200 ondansetron HCl (PF) 4 mg/2 ml injection J2405 23155054831 $ 60.00 6360000200 ondansetron HCl 2 mg/ml intravenous solution J2405 23155055031 $ 60.00 6360000200 acetaminophen 1,000 mg/100 ml (10 mg/ml) J0131 43825010201 $ 150.00

6360000200 penicillin G benzathine 1,200,000 unit/2 ml J0561 60793070102 $ 472.10 6360000200 filgrastim 480 mcg/1.6 ml injection solution J1442 55513054601 $ 1,153.06 6360000200 levofloxacin 500 mg/100 ml in 5 % dextrose J1956 25021013267 $ 70.00 6360000200 levofloxacin 750 mg/150 ml in 5 % dextrose J1956 25021013268 $ 250.00 6360000200 ciprofloxacin 400 mg/200 ml in 5 % dextrose J0744 36000000924 $ 70.00 6360000200 phytonadione (vitamin K1) 10 mg/ml injection J3430 00409915801 $ 70.00 6360000200 ibandronate 3 mg/3 ml intravenous syringe J1740 60505609700 $ 600.00 6360000200 pneumococcal 23 polyvalent vaccine 25 mcg/0.5 90732 00006494301 $ 400.00 6360000200 potassium chloride 10 meq/100ml in sterile J3480 00338070948 $ 60.00 6360000200 propofol 10 mg/ml intravenous emulsion J2704 25021060850 $ 87.60 6360000200 terbutaline 1 mg/ml subcutaneous solution J3105 00143974610 $ 70.00 6360000200 dexamethasone sodium phosphate (PF) 10 J1100 63323050601 $ 70.00 6360000200 digoxin 250 mcg/ml injection solution J1160 00641141035 $ 70.00 6360000200 hydrocortisone sodium succinate 100 mg solution J1720 00009082501 $ 70.00 6360000200 ferric carboxymaltose 50 mg iron/ml intravenous J1439 00517065002 $ 2,283.28 6360000200 acetylcysteine 200 mg/ml (20 %) solution J7608 63323069030 $ 5.75 6360000200 EPINEPHrine 0.1 mg/ml injection syringe J0171 00409492120 $ 70.00 6360000200 ipratropium bromide 0.02 % solution for J7644 00487980101 $ 5.75 6360000200 ipratropium bromide 0.02 % solution for J7644 00487980160 $ 5.75 6360000200 heparin, porcine (PF) 100 unit/ml intravenous J1642 63807060005 $ 60.00 6360000200 testosterone cypionate 200 mg/ml intramuscular J1071 00009052001 $ 70.00 6360000200 hepatitis B virus vaccine recomb (PF) 20 mcg/ml 90747 58160082152 $ 250.00 6360000200 hepatitis B virus vaccine recomb (PF) 10 mcg/0.5 90740 58160082052 $ 133.80 6360000200 hepatitis B virus vaccine recomb (PF) 10 mcg/0.5 90744 58160082011 $ 133.80 6360000200 rho(d) immune globulin 1,500 unit (300 mcg)/2 J2791 44206030001 $ 481.14 6360000200 tetanus and diphtheria tox (PF) 5 Lf unit-2 Lf 90714 49281021588 $ 156.95 6360000200 tetanus and diphtheria tox (PF) 5 Lf unit-2 Lf 90714 49281021510 $ 156.95 6360000200 diphth,pertus(ac)tetanus(pf)2 Lf-(2.5-5-3-5mcg)-5 90715 49281040015 $ 209.96 6360000200 diphth,pertus(ac)tetanus(pf)2 Lf-(2.5-5-3-5mcg)-5 90715 49281040020 $ 209.96 6360000200 dimethyl sulfoxide 50 % intravesical solution J1212 67457017750 $ 1,307.67 6360000200 methylprednisolone sod succ (PF) 125 mg/2 ml J2930 00009004722 $ 70.00 6360000200 methylprednisolone sod succ (PF) 125 mg/2 ml J2930 00009004704 $ 70.00 6360000200 methylprednisolone sod succ (PF) 500 mg/4 ml J2930 00009000302 $ 195.25 6360000200 methylprednisolone sod succ (PF) 1,000 mg/8 J2930 00009001820 $ 250.00 6360000200 filgrastim-sndz 300 mcg/0.5 ml injection syringe Q5101 61314031801 $ 600.00 6360000200 filgrastim-sndz 480 mcg/0.8 ml injection syringe Q5101 61314031210 $ 1,009.65 6360000200 pegfilgrastim 6 mg/0.6 ml subcutaneous syringe J2505 55513019001 $ 9,969.70 6360000200 chlorpromazine 25 mg/ml injection solution J3230 00641139835 $ 150.00 6360000200 darbepoetin alfa 25 mcg/0.42 ml in polysorbate J0882 55513005704 $ 580.50 6360000200 leuprolide 7.5 mg intramuscular syringe kit J9217 00074364203 $ 2,918.26 6360000200 calcium gluconate 100 mg/ml (10 %) intravenous J0610 63323036001 $ 70.00 6360000200 methylnaltrexone 12 mg/0.6 ml subcutaneous J2212 65649055107 $ 400.00 6360000200 midazolam (PF) 5 mg/ml injection solution J2250 00409230801 $ 60.00 6360000200 hum prothrombin cplx (PCC) 4factor 500 unit C9132 63833038602 $ 60.00 6360000200 hum prothrombin cplx(pcc)4fact 1,000 unit (800- C9132 63833038702 $ 60.00 6360000200 morphine 8 mg/ml intravenous syringe J2270 00409189210 $ 60.00 6360000200 mepolizumab 100 mg subcutaneous solution J2182 00173088101 $ 4,876.74 6360000200 cefazolin 1 gram solution for injection J0690 44567070725 $ 60.00 6360000200 cefazolin 1 gram solution for injection J0690 25021010167 $ 60.00 6360000200 lidocaine (PF) 4 mg/ml (0.4 %) in 5 % dextrose J2001 00264959420 $ 70.00 6360000200 morphine (PF) 1 mg/ml injection solution J2274 00641601910 $ 103.92 6360000200 cefepime 1 gram solution for injection J0692 25021012166 $ 70.00

6360000200 cefepime 2 gram solution for injection J0692 25021012267 $ 80.00 6360000200 ocrelizumab 30 mg/ml intravenous solution J2350 50242015001 $ 24,375.00 6360000200 meropenem 1 gram intravenous solution J2185 63323050825 $ 80.00 6360000200 flu vacc qs2018-19 (36 mos up)(pf)60 mcg (15 636000049281041850 $ 103.32 6360000200 piperacillin-tazobactam 4.5 gram intravenous J2543 63323032056 $ 70.00 6360000200 piperacillin-tazobactam 4.5 gram intravenous J2543 64679001201 $ 87.61 6360000200 piperacillin-tazobactam 3.375 gram intravenous J2543 63323030036 $ 70.00 6360000200 piperacillin-tazobactam 3.375 gram intravenous J2543 64679005601 $ 80.00 6360000200 DOBUTamine 500 mg/250 ml (2,000 mcg/ml) in J1250 00409234732 $ 80.00 6360000200 cyanocobalamin (vit B-12) 1,000 mcg/ml J3420 63323004401 $ 60.00 6360000200 leuprolide 22.5 mg (3 month) intramuscular J9217 00074334603 $ 7,441.55 6360000200 azithromycin 500 mg intravenous solution J0456 63323039814 $ 70.00 6360000200 amphotericin B liposome 50 mg intravenous J0289 00469305130 $ 600.00 6360000200 rabies vaccine, purified chicken embryo cell (PF) 90675 58160096412 $ 775.10 6360000200 ketorolac 30 mg/ml (1 ml) injection solution J1885 63323016216 $ 60.00 6360000200 eptifibatide 0.75 mg/ml intravenous solution J1327 70121100301 $ 690.00 6360000200 dexamethasone 4 mg tablet J8540 00054418425 $ 5.75 6360000200 dexamethasone 10 mg/ml injection solution J1100 00641036721 $ 60.00 6360000200 dexamethasone 4 mg/ml injection solution J1100 63323016516 $ 60.00 6360000200 levalbuterol 1.25 mg/3 ml solution for J7614 00093414864 $ 24.78 6360000200 sodium ferric gluconate complex in sucrose 62.5 J2916 00024279410 $ 159.00 6360000200 albuterol sulfate 2.5 mg/3 ml (0.083 %) solution J7613 00487950101 $ 5.75 6360000200 albuterol sulfate 2.5 mg/3 ml (0.083 %) solution J7613 00487950160 $ 5.75 6360000200 albuterol sulfate 2.5 mg/3 ml (0.083 %) solution J7613 04879050160 $ 5.75 6360000200 diphenhydramine 50 mg/ml injection solution J1200 63323066416 $ 60.00 6360000200 diphenhydramine 50 mg/ml injection solution J1200 63323066401 $ 60.00 6360000200 pantoprazole 40 mg intravenous solution C9113 00008400101 $ 70.00 6360000200 morphine 10 mg/ml intravenous solution J2270 00641612725 $ 60.00 6360000200 tenecteplase 50 mg intravenous kit J3101 50242012001 $ 5,979.11 6360000200 budesonide 0.5 mg/2 ml suspension for J7626 00093681673 $ 35.46 6360000200 budesonide 0.5 mg/2 ml suspension for J7626 00781751614 $ 35.46 6360000200 iron sucrose 100 mg iron/5 ml intravenous J1756 00517234099 $ 240.00 6360000200 prednisolone sodium phosphate 15 mg/5 ml (3 J7510 00121075908 $ 86.27 6360000200 crotalidae polyval immune fab solution for J0840 50633011012 $ 10,233.60 6360000200 propranolol 1 mg/ml intravenous solution J1800 00143987201 $ 70.00 6360000200 alteplase 2 mg intra-catheter solution J2997 50242004164 $ 459.18 6360000200 ertapenem 1 gram solution for injection J1335 00006384371 $ 400.00 6360000200 ertapenem 1 gram solution for injection J1335 42023022110 $ 400.00 6360000200 pamidronate 30 mg/10 ml (3 mg/ml) J2430 67457043010 $ 150.00 6360000200 furosemide 10 mg/ml injection solution J1940 63323028026 $ 60.00 6360000200 ziprasidone 20 mg/ml (final concentration) J3486 00049392020 $ 149.04 6360000200 gentamicin 40 mg/ml injection solution J1580 63323001094 $ 60.00 6360000200 zoledronic acid 4 mg/5 ml intravenous solution J3489 25021080166 $ 540.00 6360000200 haloperidol lactate 5 mg/ml injection solution J1630 63323047401 $ 60.00 6360000200 heparin (porcine) 20,000 unit/500 ml (40 J1644 00264956710 $ 70.00 6360000200 palonosetron 0.25 mg/5 ml intravenous solution J2469 62856079701 $ 1,041.90 6360000200 hydralazine 20 mg/ml injection solution J0360 63323061401 $ 290.40 6360000200 hydroxyzine HCl 50 mg/ml intramuscular J3410 00517560125 $ 128.16 6360000200 cinacalcet 60 mg tablet J0604 55513007430 $ 107.56 6360000200 acetylcysteine 200 mg/ml (20 %) intravenous J0132 55150025930 $ 112.50 6360000200 adenosine 3 mg/ml intravenous solution J0153 63323065102 $ 80.00 6360000200 natalizumab 300 mg/15 ml intravenous solution J2323 64406000801 $ 9,888.00

6360000200 aminophylline 250 mg/10 ml intravenous J0280 00409592101 $ 60.00 6360000200 LORazepam 2 mg/ml injection solution,lorazepam 2 mg/ml injection syringe J2060 00409198530 $ 60.00 6360000200 LORazepam 2 mg/ml injection solution,lorazepam 2 mg/ml injection syringe J2060 00641604425 $ 60.00 6360000200 hydrocortisone sod succinate (PF) 100 mg/2 ml solution for injection,hydrocortisone sodium J1720 00009082501 $ 70.00 6360000200 fentanyl (PF) 100 mcg/2 ml (50 mcg/ml) intravenous syringe,fentanyl (PF) 50 mcg/ml J3010 00409909332 $ 60.00 6360000200 midazolam 1 mg/ml injection solution,midazolam (PF) 1 mg/ml injection solution J2250 00409230517 $ 60.00 6360000200 amiodarone 50 mg/ml intravenous solution,amiodarone 150 mg/3 ml intravenous J0282 00143987501 $ 60.00 6360000200 amiodarone 50 mg/ml intravenous solution,amiodarone 150 mg/3 ml intravenous J0282 00143987525 $ 60.00 6360000200 ceftriaxone 1 gram solution for injection J0696 00409733201 $ 105.00 6360000200 hepatitis B virus vaccine recomb (PF) 20 mcg/ml intramuscular susp,hepatitis B virus vaccine 90746 58160082152 $ 250.00 6360000200 EPINEPHrine 1 mg/ml injection solution,epinephrine HCL (PF) 1 mg/ml (1 ml) J0171 42023015925 $ 89.76 HYDROmorphone 2 mg/ml injection 6360000200 solution,hydromorphone (PF) 2 mg/ml injection J1170 00409336511 $ 60.00 6360000200 J7613 9999999003 $ 15.34 6360000200 J7512 9999999026 $ 15.85 6360000200 J7510 9999999025 $ 16.48 6360000200 diphth,pertussis(acel),tetanus 2.5 Lf unit-8 mcg-5 90715 58160084252 $ 189.00 6360000200 glucagon (human recombinant) 1 mg/ml solution J1610 00597026010 $ 514.80 6360000200 lidocaine (PF) 40 mg/ml (4 %) injection solution J2001 00409428325 $ 70.00 6360000200 lidocaine (PF) 50 mg/5 ml (1 %) intravenous 636000000409913705 $ 70.00 6360000200 lidocaine (PF) 100 mg/5 ml (2 %) intravenous J2001 00409132305 $ 60.00 6360000200 ampicillin 2 gram solution for injection J0290 00781927395 $ 80.41 6360000200 magnesium sulfate 4 meq/ml (50 %) injection J3475 63323006426 $ 60.00 6360000200 magnesium sulfate 4 meq/ml (50 %) injection J3475 63323006403 $ 60.00 6360000200 methylprednisolone 4 mg tablet J7509 59746000106 $ 5.75 6360000200 methylprednisolone acetate 80 mg/ml J1040 00009347501 $ 110.04 6360000200 metoclopramide 5 mg/ml injection solution J2765 00703450281 $ 60.00 6360000200 nalbuphine 10 mg/ml injection solution J2300 00409146401 $ 175.65 6360000200 naloxone 1 mg/ml injection syringe J2310 76329346901 $ 165.00 6360000200 orphenadrine citrate 30 mg/ml injection solution J2360 17478053802 $ 95.16 6360000200 oxytocin 10 unit/ml injection solution J2590 42023011625 $ 60.00 6360000200 phenylephrine 10 mg/ml injection solution J2370 76014000433 $ 216.25 6360000200 phenytoin sodium 50 mg/ml intravenous solution J1165 00641255545 $ 60.00 6360000200 potassium chloride 2 meq/ml intravenous J3480 00409665305 $ 70.00 6360000200 prednisone 1 mg tablet J7512 00603533521 $ 5.75 6360000200 prednisone 10 mg tablet J7512 00143973901 $ 5.75 6360000200 prednisone 20 mg tablet J7512 00054001825 $ 5.75 6360000200 prednisone 5 mg tablet J7512 00054472825 $ 5.75 6360000200 prochlorperazine Edisylate 10 mg/2 ml (5 J0780 23155052341 $ 111.00 6360000200 promethazine 25 mg/ml injection solution J2550 00641092825 $ 60.00 6360000200 promethazine 50 mg/ml injection solution J2550 00641149631 $ 60.00 6360000200 protamine 10 mg/ml intravenous solution J2720 63323022930 $ 184.25 6360000200 atropine 0.1 mg/ml injection syringe J0461 00409163010 $ 70.00

6360000200 succinylcholine chloride 20 mg/ml injection J0330 00409662902 $ 115.08 6360000200 levetiracetam 500 mg/5 ml intravenous solution J1953 00143967310 $ 80.00 6360000200 levetiracetam 500 mg/5 ml intravenous solution J1953 63323040005 $ 70.00 6360000200 arformoterol 15 mcg/2 ml solution for J7605 63402091101 $ 64.72 6360000200 arformoterol 15 mcg/2 ml solution for J7605 63402091104 $ 64.72 6360000200 thiamine HCl (vitamin B1) 100 mg/ml injection J3411 63323001302 $ 60.00 6360000200 triamcinolone acetonide 40 mg/ml suspension J3301 70121116801 $ 70.00 6360000200 zoledronic acid 5 mg/100 ml in mannitol 5 %- J3489 00078043561 $ 2,350.00 6360000200 vancomycin 1,000 mg intravenous injection J3370 63323028426 $ 70.00 6360000200 vancomycin 1,000 mg intravenous injection J3370 63323028441 $ 70.00 6360000200 fosphenytoin 100 mg PE/2 ml injection solution Q2009 70121138105 $ 90.00 6360000200 alteplase 100 mg intravenous solution J2997 50242008525 $ 14,080.58 6360000200 alteplase 100 mg intravenous solution J2997 50242008527 $ 14,080.58 6360000200 ampicillin-sulbactam 1.5 gram solution for J0295 00049001381 $ 70.00 6360000200 ampicillin-sulbactam 3 gram solution for injection J0295 67457034903 $ 60.00 6360000200 ketorolac 60 mg/2 ml intramuscular solution J1885 63323016202 $ 70.00 6360000200 azathioprine 50 mg tablet J7500 00378100501 $ 5.75 6360000200 betamethasone acetate and sodium phos 6 J0702 00517072001 $ 247.20 6360000200 romiplostim 250 mcg subcutaneous solution J2796 55513022101 $ 3,428.46 6360000200 romiplostim 500 mcg subcutaneous solution J2796 55513022201 $ 6,135.13 6360000200 ipratropium-albuterol 0.5 mg-3 mg(2.5 mg J7620 00487020101 $ 5.75 6360000200 ipratropium-albuterol 0.5 mg-3 mg(2.5 mg J7620 69097017353 $ 5.75 6360000200 ipratropium-albuterol 0.5 mg-3 mg(2.5 mg J7620 69097017364 $ 5.75 6360000200 ipratropium-albuterol 0.5 mg-3 mg(2.5 mg J7620 76204060060 $ 5.75 6360000200 ipratropium-albuterol 0.5 mg-3 mg(2.5 mg J7620 69097017348 $ 5.75 6360000200 cefoxitin 1 gram intravenous solution J0694 25021010910 $ 80.00 6360000200 cefoxitin 1 gram intravenous solution J0694 63323034125 $ 80.00 6360000200 ceftazidime 1 gram solution for injection J0713 00409508216 $ 70.00 6360000200 ceftazidime 2 gram solution for injection J0713 25021012867 $ 119.82 6360000200 ceftriaxone 2 gram solution for injection J0696 00409733503 $ 156.25 6360000200 imipenem-cilastatin 500 mg intravenous solution J0743 63323032294 $ 80.00 6360000200 EPINEPHrine 1 mg/ml injection solution J0171 42023016801 $ 569.97 famotidine 20 mg tablet 00172572860 $ 5.75 finasteride 5 mg tablet 16729009015 $ 5.75 balsam peru-castor oil 87 mg-788 mg/gram 58980078021 $ 5.75 flavoxate 100 mg tablet 51224015450 $ 5.75 fluconazole 200 mg tablet 67405060403 $ 5.75 fludrocortisone 0.1 mg tablet 00115703301 $ 5.75 diclofenac 1 % topical gel 65162083366 $ 176.40 FLUoxetine 10 mg capsule 50111064701 $ 5.75 FLUoxetine 20 mg capsule 50111064801 $ 5.75 Lactobacil rhamnosus GG 10 billion cell-inulin 200 49100040009 $ 5.75 estradiol 10 mcg vaginal tablet 65162022623 $ 77.59 glipizide 5 mg tablet 00781145201 $ 5.75 glycopyrrolate 1 mg tablet 23155060601 $ 5.75 hydrocortisone 5 mg tablet 59762007301 $ 5.75 hydroxychloroquine 200 mg tablet 00781140797 $ 15.11 hydroxychloroquine 200 mg tablet 00781599401 $ 15.11 insulin NPH isophane U-100 human 100 unit/ml 00002831501 $ 446.10 insulin U-100 regular human 100 unit/ml 00002821517 $ 223.05 iodoquinol-hc 1 %-1 % topical cream 58980081110 $ 13.95 ketoconazole 2 % topical cream 51672129802 $ 5.86

ketoconazole 2 % topical cream 51672129803 $ 5.75 ketorolac 10 mg tablet 00093031401 $ 5.75 labetalol 100 mg tablet 00185001001 $ 5.75 ammonium lactate 12 % lotion 45802052526 $ 62.40 tamsulosin 0.4 mg capsule 00781207601 $ 5.75 levothyroxine 88 mcg tablet 00527134401 $ 5.75 levothyroxine 112 mcg tablet 00781518592 $ 5.75 levothyroxine 175 mcg tablet 00074707090 $ 5.75 lidocaine-prilocaine 2.5 %-2.5 % topical cream 00115146845 $ 5.75 lidocaine-prilocaine 2.5 %-2.5 % topical cream 00168035705 $ 7.64 methyl salicylate-menthol topical ointment 54162055501 $ 6.34 lisinopril 10 mg tablet 68180098001 $ 5.75 lisinopril 40 mg tablet 68180051701 $ 5.75 lisinopril 5 mg tablet 68180051303 $ 5.75 fluticasone 100 mcg-salmeterol 50 mcg/dose 00173069504 $ 43.35 fluticasone 250 mcg-salmeterol 50 mcg/dose 00173069600 $ 29.00 fluticasone 250 mcg-salmeterol 50 mcg/dose 00173069604 $ 43.35 fluticasone 500 mcg-salmeterol 50 mcg/dose 00173069704 $ 70.66 loratadine 10 mg tablet 45802065078 $ 5.75 magnesium oxide 400 mg (241.3 mg magnesium) 00904660961 $ 5.75 magnesium oxide 400 mg (241.3 mg magnesium) 63739035401 $ 5.75 metformin 500 mg tablet 23155010201 $ 5.75 metolazone 2.5 mg tablet 00378617201 $ 8.33 metronidazole 0.75 % vaginal gel 00781707787 $ 8.07 midodrine 5 mg tablet 00245021211 $ 5.75 neomycin 3.5 mg/g-polymyxin B 10,000 unit/g- 00574416035 $ 66.60 misoprostol 200 mcg tablet 43386016106 $ 5.75 HYDROcodone 10 mg-chlorpheniramine 8 mg/5 ml oral susp extend.rel 12hr 27808008601 $ 5.75 dabigatran etexilate 75 mg capsule 00597035556 $ 29.00 mupirocin 2 % topical ointment 51672131200 $ 5.75 mupirocin 2 % topical ointment 45802011222 $ 35.99 NIFEdipine ER 60 mg tablet,extended release 00591319401 $ 5.75 nitrofurantoin monohydrate/macrocrystals 100 00378342201 $ 11.85 nitrofurantoin monohydrate/macrocrystals 100 00185012201 $ 11.86 omega-3 fatty acids-fish oil 300 mg-1,000 mg 30768003304 $ 5.75 electrolytes-dextrose oral solution 70074080365 $ 5.75 oxycodone 5 mg tablet 10702001801 $ 5.75 peg 3350-electrolytes 236 gram-22.74 gram-6.74 43386009019 $ 64.00 PARoxetine 20 mg tablet 60505008302 $ 5.75 PARoxetine 20 mg tablet 00904567761 $ 5.75 PARoxetine 30 mg tablet 00378700393 $ 5.75 linagliptin 5 mg tablet 00597014030 $ 54.86 rivaroxaban 10 mg tablet 50458058030 $ 55.88 calcium polycarbophil 625 mg tablet 00536430605 $ 5.75 oseltamivir 6 mg/ml oral suspension 00004082205 $ 33.75 pravastatin 10 mg tablet 68462019590 $ 5.75 pravastatin 20 mg tablet 68462019690 $ 5.75 pravastatin 20 mg tablet 68382007116 $ 5.75 pravastatin 40 mg tablet 60505017009 $ 5.75 pravastatin 40 mg tablet 68462019790 $ 5.75 pravastatin 40 mg tablet 42291066890 $ 5.75

ferrous gluconate 324 mg (37.5 mg iron) tablet 00904213761 $ 5.75 primidone 50 mg tablet 00603537121 $ 5.75 prochlorperazine 25 mg rectal suppository 00713013512 $ 39.23 promethazine 12.5 mg rectal suppository 00713053612 $ 38.99 promethazine 25 mg rectal suppository 00713052612 $ 22.52 quinapril 20 mg tablet 69097084205 $ 5.75 ramipril 1.25 mg capsule 00054010625 $ 5.75 ramipril 2.5 mg capsule 65862047501 $ 5.75 ranitidine 150 mg tablet 65162025350 $ 5.75 rivaroxaban 15 mg tablet 50458057830 $ 37.25 rivaroxaban 20 mg tablet 50458057990 $ 29.00 acetazolamide 250 mg tablet 23155028801 $ 10.66 racepinephrine 2.25 % solution for nebulization 00487590102 $ 6.01 sertraline 100 mg tablet 68180035302 $ 5.75 sertraline 50 mg tablet 68180035202 $ 5.75 simvastatin 10 mg tablet 16729000415 $ 5.75 simvastatin 20 mg tablet 68180047902 $ 5.75 simvastatin 40 mg tablet 16729000615 $ 5.75 sodium phosphates 19 gram-7 gram/118 ml 00132020140 $ 5.75 sotalol 80 mg tablet 60505008000 $ 5.75 sucralfate 1 gram tablet 00093221005 $ 5.75 magnesium 64 mg (magnesium chloride) 68585000575 $ 5.75 tamoxifen 20 mg tablet 00378027493 $ 5.75 timolol maleate 0.25 % eye drops 64980051301 $ 29.00 tobramycin 0.3 %-dexamethasone 0.1 % eye 24208029505 $ 354.90 sulfamethoxazole 800 mg-trimethoprim 160 mg 53746027201 $ 5.75 vancomycin 125 mg capsule 68180016611 $ 23.10 warfarin 1 mg tablet 00093171201 $ 5.75 warfarin 1 mg tablet 00056016975 $ 9.53 ipratropium 20 mcg-albuterol 100 mcg/actuation 00597002402 $ 856.78 mirabegron ER 25 mg tablet,extended release 24 00469260190 $ 47.01 zolpidem 5 mg tablet 00378530501 $ 10.70 morphine ER 30 mg tablet,extended release 42858080201 $ 5.75 diclofenac 50 mg-misoprostol 200 mcg 59762002802 $ 12.39 apixaban 2.5 mg tablet 00003089321 $ 29.00 morphine ER 15 mg tablet,extended release 42858080101 $ 5.75 morphine ER 60 mg tablet,extended release 42858080301 $ 5.75 morphine ER 100 mg tablet,extended release 42858080401 $ 5.75 apixaban 5 mg tablet 00003089421 $ 16.13 meclizine 12.5 mg tablet 00536101701 $ 5.75 memantine 14 mg capsule sprinkle,extended 00456341490 $ 29.00 doxylamine 10 mg-pyridoxine (vit B6) 10 mg 55494010010 $ 54.88 magnesium hydroxide 400 mg/5 ml oral 00121043130 $ 9.01 venlafaxine 100 mg tablet 57664039688 $ 5.75 venlafaxine 75 mg tablet 52817013310 $ 5.75 venlafaxine 37.5 mg tablet 57664039388 $ 5.75 oxycodone ER 10 mg tablet,crush 59011041010 $ 16.98 oxycodone ER 10 mg tablet,crush 59011041020 $ 17.44 oxycodone ER 20 mg tablet,crush 59011042010 $ 15.84 cholestyramine-aspartame 4 gram oral powder 49884046663 $ 9.48 fluocinonide-emollient 0.05 % topical cream 00093026330 $ 11.87 activated charcoal-sorbitol 25 gram/120 ml oral 00574012074 $ 53.28

activated charcoal 25 gram/120 ml oral 00574012104 $ 53.28 insulin aspart U-100 100 unit/ml subcutaneous 00169633910 $ 400.00 insulin glargine (U-100) 100 unit/ml (3 ml) 00088221905 $ 323.44 insulin glargine (U-100) 100 unit/ml (3 ml) 00002771559 $ 261.08 insulin lispro (U-100) 100 unit/ml subcutaneous 00002879959 $ 400.00 insulin detemir (U-100) 100 unit/ml (3 ml) 00169643810 $ 352.50 insulin aspar prot-insulin aspart 100 unit/ml (70-00169369619 $ 400.00 liraglutide 0.6 mg/0.1 ml (18 mg/3 ml) 00169406013 $ 70.00 estradiol 0.5 mg tablet 00555089902 $ 5.75 sodium chloride-aloe vera nasal gel 00225052547 $ 5.75 aspirin-sod bicarb-citric acid 325 mg-1,916 mg- 16500004012 $ 5.75 trolamine salicylate-aloe vera 10 % topical cream 41167005703 $ 5.75 carbidopa ER 25 mg-levodopa 100 mg 00378008801 $ 5.75 multivit-min-fa 100 mcg-lut 1.66 mg-zeaxanth 00065804083 $ 5.75 terbinafine HCl 250 mg tablet 51991052633 $ 5.75 tiotropium bromide 2.5 mcg/actuation mist for 00597010061 $ 914.62 umeclidinium 62.5 mcg/actuation blister powder 00173087310 $ 5.75 naloxegol 25 mg tablet 00310197030 $ 46.00 white petrolatum-mineral oil 83 %-15 % eye 00904648838 $ 5.75 white petrolatum-mineral oil 83 %-15 % eye 00536108691 $ 5.75 scopolamine 1 mg over 3 days transdermal patch 66758020854 $ 71.33 pentosan polysulfate sodium 100 mg capsule 50458009801 $ 35.46 thyroid (pork) 30 mg tablet 00456045801 $ 5.75 calcium carbonate 500 mg calcium (1,250 mg) 00904188372 $ 5.75 thiamine mononitrate (vitamin B1) 100 mg tablet 50268085111 $ 5.75 salt irrigation solution no.3 2.1 % nasal solution 51817060223 $ 5.75 verapamil ER (SR) 240 mg tablet,extended release 68462026001 $ 5.75 lisinopril 2.5 mg tablet 68180051201 $ 5.75 valacyclovir 1 gram tablet 00378427693 $ 5.75 valacyclovir 500 mg tablet 51079009301 $ 14.10 naproxen sodium 220 mg tablet 10939063544 $ 5.75 naproxen sodium 220 mg tablet 00536109401 $ 5.75 verapamil ER (SR) 120 mg tablet,extended release 51079089401 $ 8.92 methyl salicylate 15 %-menthol 1 % topical cream 00178032005 $ 5.75 SUMAtriptan 100 mg tablet 55111029309 $ 5.75 acidophilus 25 million cell-pectin, citrus 100 mg 00536718001 $ 5.75 carbamazepine 100 mg chewable tablet 51672404101 $ 5.75 carbamazepine 200 mg tablet 13668026801 $ 5.91 fluconazole 150 mg tablet 57237000511 $ 5.75 carbamide peroxide 6.5 % ear drops 00904322035 $ 5.75 potassium chloride ER 10 meq capsule,extended 53746054205 $ 5.75 potassium chloride ER 10 meq capsule,extended 66758020505 $ 5.75 carisoprodol 350 mg tablet 64980017401 $ 5.75 carisoprodol 350 mg tablet 00603258221 $ 5.75 lamotrigine 25 mg tablet 51672413001 $ 5.75 lamotrigine 100 mg tablet 51672413101 $ 5.75 acetaminophen 300 mg-codeine 30 mg tablet 00406048401 $ 5.75 acetaminophen 300 mg-codeine 30 mg tablet 00093015001 $ 5.75 diltiazem ER 60 mg capsule,extended release 12 00378606001 $ 11.73 ketoconazole 2 % shampoo 10147075004 $ 5.75 terazosin 1 mg capsule 59746038306 $ 5.75 terazosin 2 mg capsule 59746038406 $ 5.75

terazosin 5 mg capsule 59746038506 $ 5.75 tramadol 50 mg tablet 63739067110 $ 5.75 tramadol 50 mg tablet 57664037718 $ 5.75 metformin 850 mg tablet 23155010301 $ 5.75 tizanidine 2 mg tablet 57664050289 $ 5.75 tizanidine 4 mg tablet 00904641861 $ 5.75 losartan 25 mg tablet 65862020190 $ 5.75 losartan 50 mg tablet 65862020290 $ 5.75 fosfomycin tromethamine 3 gram oral packet 00456430001 $ 277.83 SUMAtriptan 50 mg tablet 55111029236 $ 5.75 diclofenac sodium 75 mg tablet,delayed release 61442010301 $ 5.75 calcitonin (salmon) 200 unit/actuation nasal spray 49884016111 $ 13.34 carvedilol 6.25 mg tablet 68382009301 $ 5.75 carvedilol 25 mg tablet 68382009501 $ 5.75 carvedilol 25 mg tablet 68462016501 $ 5.75 carvedilol 12.5 mg tablet 68382009401 $ 5.75 azithromycin 200 mg/5 ml oral suspension 00093202623 $ 104.64 azithromycin 200 mg/5 ml oral suspension 00093202631 $ 104.64 azithromycin 200 mg/5 ml oral suspension 70710145802 $ 84.24 ipratropium bromide 0.03 % nasal spray 00054004544 $ 126.00 chlordiazepoxide 10 mg capsule 00555003302 $ 5.75 chlordiazepoxide 25 mg capsule 00555015902 $ 5.75 chlordiazepoxide 5 mg capsule 51079037401 $ 5.75 glimepiride 1 mg tablet 16729000101 $ 5.75 glimepiride 2 mg tablet 68084032611 $ 5.75 glimepiride 4 mg tablet 16729000301 $ 5.75 bupropion HCl 150 mg tablet,12 hr sustained- 00591354360 $ 5.75 ferrous sulfate 220 mg (44 mg iron)/5 ml oral 00904146516 $ 5.75 ferrous sulfate 220 mg (44 mg iron)/5 ml oral 50383077816 $ 5.75 chlorthalidone 25 mg tablet 51079005801 $ 5.75 PARoxetine 10 mg tablet 00378700193 $ 5.75 PARoxetine 40 mg tablet 00378700493 $ 5.75 lidocaine 4 % topical patch 41167005840 $ 5.75 lidocaine 4 % topical patch 46581083006 $ 54.96 theophylline ER 400 mg tablet,extended release 42858070101 $ 5.75 sodium polystyrene sulfonate 15 gram-sorbitol 20 46287000660 $ 36.00 magnesium 70 mg (magnesium chloride) 00904791152 $ 5.75 melatonin 3 mg tablet 00904518252 $ 5.75 clindamycin HCl 150 mg capsule 63304069201 $ 5.75 insulin lispro (U-100) 100 unit/ml subcutaneous 00002751001 $ 505.44 buspirone 15 mg tablet 68382018201 $ 5.75 mirtazapine 30 mg tablet 00093720756 $ 5.75 mirtazapine 15 mg tablet 00093720656 $ 5.75 clonidine HCl 0.1 mg tablet 29300013501 $ 5.75 clotrimazole 1 % topical cream 00904782231 $ 5.75 albuterol sulfate HFA 90 mcg/actuation aerosol 00173068220 $ 188.12 albuterol sulfate HFA 90 mcg/actuation aerosol 00173068224 $ 85.70 albuterol sulfate HFA 90 mcg/actuation aerosol 59310057922 $ 208.49 brimonidine 0.2 % eye drops 24208041110 $ 109.00 brimonidine 0.2 % eye drops 61314014310 $ 112.00 OLANZapine 5 mg tablet 43598016430 $ 5.75 OLANZapine 10 mg tablet 43598016630 $ 5.75

colchicine 0.6 mg tablet 64764011907 $ 29.00 peg-electrolyte solution 420 gram oral solution 52268040001 $ 112.00 bisoprolol 10 mg-hydrochlorothiazide 6.25 mg 29300018913 $ 5.75 gabapentin 400 mg capsule 67877022405 $ 5.75 gabapentin 300 mg capsule 67877022305 $ 5.75 gabapentin 100 mg capsule 67877022201 $ 5.75 gabapentin 100 mg capsule 67877022205 $ 5.75 risperidone 1 mg tablet 50458059260 $ 5.75 bupropion HCl SR 100 mg tablet,12 hr sustained- 00185041001 $ 5.75 bupropion HCl SR 150 mg tablet,12 hr sustained- 00185041501 $ 5.75 carvedilol 3.125 mg tablet 00378363101 $ 5.75 carvedilol 3.125 mg tablet 68462016201 $ 5.75 latanoprost 0.005 % eye drops 61314054701 $ 5.75 donepezil 10 mg tablet 43547027609 $ 5.75 levofloxacin 500 mg tablet 55111028050 $ 5.75 hydrochlorothiazide 12.5 mg capsule 29300013001 $ 5.75 hydrochlorothiazide 12.5 mg capsule 00591034701 $ 5.75 atorvastatin 10 mg tablet 00378395077 $ 5.75 atorvastatin 40 mg tablet 00378395277 $ 5.75 atorvastatin 20 mg tablet 00093505998 $ 5.75 warfarin 3 mg tablet 00093171501 $ 5.75 warfarin 3 mg tablet 00056018875 $ 5.75 calcium carbonate 500 mg (1,250 mg)-vitamin D3 37864000032 $ 5.75 benzocaine 20 % gum/denture cream 41167005302 $ 5.75 clindamycin 1 % lotion 00168020360 $ 8.88 metronidazole 0.75 % topical gel 00115147446 $ 34.00 ofloxacin 0.3 % eye drops 64980051505 $ 205.21 sertraline 25 mg tablet 68180035109 $ 5.75 cyanocobalamin (vit B-12) 100 mcg tablet 00536354201 $ 5.75 cyanocobalamin (vit B-12) 500 mcg tablet 96295012778 $ 5.75 cyclobenzaprine 10 mg tablet 00603307921 $ 5.75 meloxicam 7.5 mg tablet 68180050101 $ 5.75 imiquimod 5 % topical cream packet 45802036862 $ 29.00 azithromycin 250 mg tablet Q0144 50111078751 $ 11.55 azithromycin 250 mg tablet Q0144 68180016011 $ 6.50 OLANZapine 2.5 mg tablet 55111016330 $ 5.75 citalopram 20 mg tablet 00378623201 $ 5.75 pramipexole 0.125 mg tablet 68462033090 $ 5.75 pramipexole 0.25 mg tablet 68382019716 $ 5.75 dapsone 100 mg tablet 49938010130 $ 5.75 warfarin 4 mg tablet 00056016875 $ 5.75 warfarin 4 mg tablet 51672403101 $ 5.75 letrozole 2.5 mg tablet 51991075933 $ 5.75 ropinirole 0.25 mg tablet 00054011625 $ 5.75 ropinirole 0.5 mg tablet 43547026910 $ 5.75 QUEtiapine 25 mg tablet 67877024201 $ 5.75 QUEtiapine 200 mg tablet 67877024601 $ 5.75 clopidogrel 75 mg tablet 16729021816 $ 5.75 cefdinir 300 mg capsule 00781217660 $ 5.75 montelukast 10 mg tablet 00054025922 $ 5.75 sulfamethoxazole 200 mg-trimethoprim 40 mg/5 65862049647 $ 412.31 losartan 100 mg tablet 65862020390 $ 5.75

losartan 100 mg tablet 43547036209 $ 5.75 ursodiol 250 mg tablet 49884041201 $ 9.91 tolterodine 2 mg tablet 00093001806 $ 6.28 camphor-menthol 0.5 %-0.5 % lotion 73462006285 $ 5.75 simvastatin 80 mg tablet 16729000715 $ 5.75 lidocaine 5 % topical cream 00496089230 $ 5.75 citalopram 40 mg tablet 00378623301 $ 5.75 diazepam 5 mg tablet 00172392660 $ 5.75 dicloxacillin 250 mg capsule 00093312301 $ 5.75 dicloxacillin 500 mg capsule 00093312501 $ 5.75 dicyclomine 20 mg tablet 00378162001 $ 5.75 isosorbide mononitrate ER 60 mg tablet,extended 62175011937 $ 5.75 digoxin 125 mcg tablet 00143124001 $ 5.75 digoxin 250 mcg tablet 49884049401 $ 5.75 oxybutynin chloride ER 5 mg tablet,extended 00378660501 $ 10.79 oxybutynin chloride ER 10 mg tablet,extended 00378661001 $ 5.75 cilostazol 50 mg tablet 60505252101 $ 5.75 cilostazol 100 mg tablet 00093206406 $ 5.75 celecoxib 100 mg capsule 59762151601 $ 5.75 celecoxib 200 mg capsule 69097042107 $ 5.75 isosorbide mononitrate ER 30 mg tablet,extended 62175012837 $ 5.75 lisinopril 10 mg-hydrochlorothiazide 12.5 mg 68180051801 $ 5.75 diltiazem 120 mg tablet 00093032101 $ 5.75 diltiazem 30 mg tablet 00093031801 $ 5.75 diltiazem 60 mg tablet 51079074601 $ 5.75 dextromethorphan-guaifenesin 30 mg-600 mg 63824005640 $ 5.75 dimenhydrinate 50 mg tablet 00904205159 $ 5.75 ciprofloxacin 500 mg tablet 00143992801 $ 5.75 diphenoxylate-atropine 2.5 mg-0.025 mg tablet 00378041501 $ 5.75 verapamil ER 120 mg 24 hr capsule,extended 00378632001 $ 6.72 amoxicillin 400 mg/5 ml oral suspension 00143988701 $ 29.00 glucosamine-chondroitin 500 mg-400 mg tablet 43292056003 $ 5.75 polyethylene glycol 3350 17 gram oral powder 00904642286 $ 5.75 fexofenadine 180 mg tablet 00904621446 $ 5.75 risperidone 0.25 mg tablet 68382011214 $ 5.75 risperidone 0.25 mg tablet 00904635761 $ 5.75 risperidone 0.5 mg tablet 50458059110 $ 5.75 risperidone 0.5 mg tablet 68382011314 $ 5.75 pioglitazone 15 mg tablet 16729002010 $ 5.75 pioglitazone 45 mg tablet 16729002215 $ 5.75 gabapentin 600 mg tablet 68462012601 $ 5.75 doxepin 10 mg capsule 00378104901 $ 5.75 pantoprazole 40 mg tablet,delayed release 65862056090 $ 5.75 doxycycline hyclate 100 mg capsule 00143314250 $ 5.75 oseltamivir 75 mg capsule 00004080085 $ 29.00 oseltamivir 75 mg capsule 70710101002 $ 18.85 levetiracetam 500 mg tablet 31722053712 $ 5.75 ciclopirox 8 % topical solution 51672530200 $ 34.00 theophylline ER 200 mg capsule,extended release 52244020010 $ 13.72 nitroglycerin 0.1 mg/hr transdermal 24 hour 00378910216 $ 5.75 nitroglycerin 0.2 mg/hr transdermal 24 hour 68382030930 $ 5.75 nitroglycerin 0.4 mg/hr transdermal 24 hour 00904549646 $ 5.75

felodipine ER 5 mg tablet,extended release 24 hr 13668013301 $ 5.75 pseudoephedrine-guaifenesin ER 60 mg-600 mg 63824005718 $ 5.75 divalproex 125 mg capsule,delayed release 68382010601 $ 5.75 NIFEdipine ER 60 mg tablet,extended release 24 68682010910 $ 5.75 lansoprazole 15 mg capsule,delayed release 00781214731 $ 9.24 lansoprazole 30 mg capsule,delayed release 00378803093 $ 9.24 omeprazole 20 mg capsule,delayed release 60505006501 $ 5.75 omeprazole 40 mg capsule,delayed release 00781223401 $ 5.75 omeprazole 40 mg capsule,delayed release 60505014602 $ 5.75 venlafaxine ER 37.5 mg capsule,extended release 65862052790 $ 5.75 venlafaxine ER 75 mg capsule,extended release 65862052890 $ 5.75 fentanyl 25 mcg/hr transdermal patch 60505700600 $ 21.11 fentanyl 50 mcg/hr transdermal patch 60505700702 $ 39.20 fentanyl 75 mcg/hr transdermal patch 60505700802 $ 49.49 fentanyl 100 mcg/hr transdermal patch 60505700902 $ 77.60 carboxymethylcellulose sodium 1 % eye liquid gel 00023920515 $ 34.00 chlorhexidine gluconate 4 % topical liquid 32551093835 $ 5.75 lidocaine 5 % topical patch 00603188010 $ 29.95 linezolid 600 mg tablet 59762130701 $ 38.52 salmeterol 50 mcg/dose blister powder for 00173052000 $ 31.73 HYDROcodone 10 mg-acetaminophen 325 mg 43386035801 $ 5.75 insulin aspart U-100 100 unit/ml subcutaneous 00169750111 $ 665.53 ergocalciferol (vitamin D2) 50,000 unit capsule 64380073706 $ 5.75 NIFEdipine ER 30 mg tablet,extended release 24 68682010810 $ 5.75 atorvastatin 80 mg tablet 00093505798 $ 5.75 glyburide 5 mg-metformin 500 mg tablet 65862008201 $ 5.75 hydrocortisone 2.5 % topical cream with perineal 64980032430 $ 9.71 erythromycin 5 mg/gram (0.5 %) eye ointment 24208091055 $ 60.80 metformin ER 500 mg tablet,extended release 62756014201 $ 5.75 alendronate 70 mg tablet 69097022416 $ 5.75 QUEtiapine 300 mg tablet 47335090688 $ 5.75 diltiazem ER 120 mg capsule,24 hr,extended 68682036790 $ 5.75 diltiazem CD 120 mg capsule,extended release 63739028331 $ 5.75 diltiazem CD 180 mg capsule,extended release 68084005311 $ 5.75 diltiazem CD 240 mg capsule,extended release 10370083109 $ 5.75 diltiazem ER (XR/XT) 180 mg capsule,extended 00378528001 $ 5.75 diltiazem ER (XR/XT) 240 mg capsule,extended 60505001606 $ 5.75 clotrimazole-betamethasone 1 %-0.05 % topical 00168025815 $ 5.75 tolterodine ER 2 mg capsule,extended release 24 00378340293 $ 29.00 tolterodine ER 4 mg capsule,extended release 24 00093716498 $ 14.85 sodium chloride 0.65 % nasal spray aerosol 00904386575 $ 5.75 esomeprazole magnesium 20 mg capsule,delayed 00186502054 $ 33.46 esomeprazole magnesium 20 mg capsule,delayed 00093645098 $ 23.62 esomeprazole magnesium 40 mg capsule,delayed 00186504054 $ 19.32 esomeprazole magnesium 40 mg capsule,delayed 00093645198 $ 23.19 metoprolol succinate ER 25 mg tablet,extended 62037083001 $ 5.75 metoprolol succinate ER 50 mg tablet,extended 62037083101 $ 5.75 metoprolol succinate ER 100 mg tablet,extended 68084067311 $ 5.75 metoprolol succinate ER 200 mg tablet,extended 49884082801 $ 5.75 citalopram 10 mg tablet 00378623101 $ 5.75 ferrous gluconate 324 mg (38 mg iron) tablet 00574050801 $ 5.75 ferrous sulfate 220 mg (44 mg iron)/5 ml oral 05361015516 $ 5.75

ferrous sulfate 325 mg (65 mg iron) tablet 00904759180 $ 5.75 allopurinol 100 mg tablet 00378013701 $ 5.75 allopurinol 300 mg tablet 00603211621 $ 5.75 allopurinol 300 mg tablet 70710121001 $ 5.75 valsartan 80 mg tablet 43547036809 $ 5.75 oxycodone-acetaminophen 10 mg-325 mg 00406052301 $ 5.75 fluorometholone 0.1 % eye drops,suspension 60758088005 $ 248.68 folic acid 1 mg tablet 00603316221 $ 5.75 folic acid 1 mg tablet 11534016501 $ 5.75 ALPRAZolam 0.25 mg tablet 67253090010 $ 5.75 ALPRAZolam 0.25 mg tablet 51079078801 $ 5.75 ALPRAZolam 0.5 mg tablet 67253090110 $ 5.75 risedronate 35 mg tablet 00430047203 $ 46.44 furosemide 10 mg/ml oral solution 00054329446 $ 29.00 furosemide 20 mg tablet 00054429731 $ 5.75 furosemide 40 mg tablet 00378021610 $ 5.75 furosemide 80 mg tablet 00378023201 $ 5.75 amoxicillin 500 mg-potassium clavulanate 125 mg 66685100200 $ 6.52 amoxicillin 875 mg-potassium clavulanate 125 mg 66685100100 $ 23.33 amoxicillin 400 mg-potassium clavulanate 57 65862053401 $ 58.40 escitalopram 10 mg tablet 00093585101 $ 5.75 escitalopram 20 mg tablet 00093585201 $ 5.75 valsartan 40 mg tablet 43547036703 $ 5.75 gemfibrozil 600 mg tablet 69097082103 $ 5.75 dutasteride 0.5 mg capsule 00173071215 $ 29.00 ezetimibe 10 mg tablet 49884022811 $ 9.67 propylene glycol 1 %-glycerin 0.3 % eye drops 10119002003 $ 5.75 gentian violet 1 % topical solution 00395100392 $ 5.75 ARIPiprazole 10 mg tablet 60505267403 $ 5.75 HYDROcodone 5 mg-acetaminophen 325 mg 53746010905 $ 5.75 HYDROcodone 5 mg-acetaminophen 325 mg 00904656761 $ 5.75 HYDROcodone 7.5 mg-acetaminophen 325 mg 00603389128 $ 5.75 HYDROcodone 7.5 mg-acetaminophen 325 mg 00904642061 $ 5.75 HYDROcodone 7.5 mg-acetaminophen 325 mg 65162011550 $ 5.75 guaifenesin 400 mg tablet 57896079401 $ 5.75 neomycin-polymyxin-hydrocort 3.5 mg/ml- 24208063110 $ 293.65 neomycin-polymyxin-hydrocort 3.5 mg/ml- 61314064610 $ 262.57 glyburide 5 mg tablet 23155005801 $ 5.75 rosuvastatin 20 mg tablet 00310075290 $ 10.04 cyclobenzaprine 5 mg tablet 00591325601 $ 5.75 coenzyme Q10 50 mg capsule 79854000848 $ 5.75 haloperidol 1 mg tablet 00378025701 $ 5.75 haloperidol 2 mg tablet 00781139301 $ 5.75 peg 400-propylene glycol 0.4 %-0.3 % eye drops 00065143105 $ 5.75 potassium chloride ER 20 meq tablet,extended 00781572010 $ 5.75 potassium chloride ER 20 meq tablet,extended 66758019006 $ 5.75 menthol 5 % topical patch 41167000843 $ 5.75 amantadine HCl 100 mg capsule 00832201200 $ 7.46 ARIPiprazole 5 mg tablet 13668021730 $ 5.75 levetiracetam 100 mg/ml oral solution 16714035801 $ 167.21 rosuvastatin 5 mg tablet 00781540092 $ 5.75 bupropion HCl XL 150 mg 24 hr tablet, extended 10370010103 $ 6.03

phenylephrine 0.125 % nasal drops 56184012105 $ 5.75 amiodarone 100 mg tablet 51862015430 $ 12.88 amiodarone 100 mg tablet 51862024030 $ 12.88 memantine 10 mg tablet 29300017216 $ 5.75 alfuzosin ER 10 mg tablet,extended release 24 hr 60505285001 $ 5.75 hydralazine 25 mg tablet 23155000201 $ 5.75 hydrochlorothiazide 25 mg tablet 16729018301 $ 5.75 hydrocortisone 1 % topical cream 45802043803 $ 9.70 hydrocortisone 2.5 % topical cream 00168008031 $ 5.75 hydrocortisone 10 mg tablet 68084046911 $ 5.75 hydrocortisone 20 mg tablet 59762007501 $ 5.75 hydrocortisone acetate 25 mg rectal suppository 00713050312 $ 26.56 HYDROmorphone 2 mg tablet 42858030101 $ 5.75 escitalopram 5 mg tablet 00378385577 $ 5.75 metoprolol tartrate 25 mg tablet 00378001805 $ 5.75 glipizide ER 5 mg tablet, extended release 24 hr 68084011111 $ 5.75 glipizide ER 10 mg tablet, extended release 24 hr 59762054202 $ 5.75 guaifenesin ER 600 mg tablet, extended release 63824000840 $ 5.75 hydroxyzine HCl 25 mg tablet 10702001101 $ 5.75 hydroxyzine HCl 25 mg tablet 23155050101 $ 5.75 HYDROcodone 7.5 mg-acetaminophen 325 mg/15 66689002316 $ 167.21 propranolol ER 60 mg capsule,24 hr,extended 51991081701 $ 5.75 lactulose 10 gram/15 ml oral solution 50383077932 $ 5.75 tiotropium bromide 18 mcg capsule with 00597007575 $ 63.01 ibuprofen 400 mg tablet 67877031901 $ 5.75 ibuprofen 600 mg tablet 55111068301 $ 5.75 ibuprofen 800 mg tablet 53746046601 $ 5.75 vitamin B complex and vitamin C no.20-folic acid 69543026010 $ 5.75 amiloride 5 mg tablet 00574029201 $ 5.75 nystatin 100,000 unit/gram topical powder 00832046530 $ 6.57 DULoxetine 20 mg capsule,delayed release 57237001760 $ 5.75 DULoxetine 30 mg capsule,delayed release 57237001830 $ 5.75 DULoxetine 60 mg capsule,delayed release 57237001930 $ 5.75 DULoxetine 60 mg capsule,delayed release 57237001999 $ 5.75 solifenacin 5 mg tablet 51248015003 $ 48.49 darifenacin ER 7.5 mg tablet,extended release 24 69097043102 $ 32.76 isosorbide dinitrate 10 mg tablet 00143177101 $ 5.75 fluticasone 110 mcg/actuation HFA aerosol 00173071920 $ 559.56 fluticasone 220 mcg/actuation HFA aerosol 00173072020 $ 869.15 cholecalciferol (vitamin D3) 1,000 unit tablet,cholecalciferol (vitamin D3) 1,000 unit 79854005023 $ 5.75 cholecalciferol (vitamin D3) 5,000 unit capsule,cholecalciferol (vitamin D3) 5,000 unit 00904598660 $ 5.75 cholecalciferol (vitamin D3) 400 unit tablet,cholecalciferol (vitamin D3) 400 unit 00904582360 $ 5.75 loperamide 2 mg capsule,loperamide 2 mg tablet 00378210001 $ 5.75 capsule,lactobacillus rhamnosus GG 15 billion cell sprinkle capsule,lactobacillus acidophilus 75 million cell-pectin 100 mg capsule 49100038164 $ 5.75 09999307701 $ 28.90 09999307801 $ 28.35 09999307901 $ 25.87

09999308001 $ 28.63 dextromethorphan-guaifenesin 10 mg-100 mg/5 ml syrup,dextromethorphan-guaifenesin 10 mg- 00031873612 $ 20.72 dextromethorphan-guaifenesin 10 mg-100 mg/5 ml syrup,dextromethorphan-guaifenesin 10 mg- 70000030101 $ 25.62 dextromethorphan-guaifenesin 10 mg-100 mg/5 ml syrup,dextromethorphan-guaifenesin 10 mg- 96295013210 $ 25.62 cocaine 4 % topical solution,cocaine 4 % nasal 00527172874 $ 156.18 morphine concentrate 20 mg/ml oral syringe (FOR ORAL USE ONLY),morphine concentrate 100 00406800330 $ 5.75 polyethylene glycol 3350 17 gram oral powder packet,polyethylene glycol 3350 17 gram/dose 45802086801 $ 18.69 polyethylene glycol 3350 17 gram oral powder packet,polyethylene glycol 3350 17 gram/dose 45802086802 $ 29.51 polyethylene glycol 3350 17 gram oral powder packet,polyethylene glycol 3350 17 gram/dose 00904642286 $ 5.75 potassium chloride ER 10 meq tablet,extended release,potassium chloride ER 10 meq 66758016005 $ 5.75 09999308401 $ 20.25 9999999000 $ 21.19 9999999007 $ 43.05 9999999001 $ 15.55 9999999014 $ 17.15 9999999023 $ 15.55 9999999002 $ 35.17 9999999004 $ 14.44 9999999005 $ 14.95 09999308301 $ 17.21 09999308101 $ 14.31 9999999006 $ 20.13 9999999008 $ 36.75 9999999009 $ 14.54 9999999010 $ 14.59 9999999013 $ 19.21 9999999011 $ 14.29 9999999015 $ 14.01 9999999016 $ 14.19 9999999019 $ 29.13 9999999022 $ 59.31 9999999024 $ 14.96 9999999029 $ 19.99 9999999031 $ 14.55 9999999030 $ 14.20 9999999012 $ 28.95 9999999017 $ 30.40 9999999018 $ 265.45 09999308501 $ 15.45 9999308201 $ 28.75 glycerin (adult) rectal suppository 00132007912 $ 5.75 ibandronate 150 mg tablet 55111057511 $ 56.67 fentanyl 12 mcg/hr transdermal patch 60505701000 $ 64.96 mometasone 220 mcg (14 doses) breath 00085134106 $ 258.86

pregabalin 25 mg capsule 00071101268 $ 29.73 pregabalin 50 mg capsule 00071101368 $ 17.17 pregabalin 75 mg capsule 00071101468 $ 11.45 pregabalin 100 mg capsule 00071101568 $ 29.73 losartan 100 mg-hydrochlorothiazide 12.5 mg 13668011790 $ 5.75 leucovorin calcium 5 mg tablet 00054449613 $ 5.75 levothyroxine 25 mcg tablet 00527134101 $ 5.75 levothyroxine 50 mcg tablet 00378180377 $ 5.75 levothyroxine 75 mcg tablet 00378180577 $ 5.75 levothyroxine 100 mcg tablet 00378180977 $ 5.75 levothyroxine 125 mcg tablet 00378181377 $ 5.75 levothyroxine 150 mcg tablet 00378181577 $ 5.75 amoxicillin 250 mg capsule 00781202001 $ 5.75 liothyronine 25 mcg tablet 42794001902 $ 5.75 amoxicillin 500 mg capsule 00781261301 $ 5.75 amoxicillin 250 mg chewable tablet 00093226801 $ 5.75 lisinopril 20 mg tablet 00378207510 $ 5.75 lisinopril 20 mg tablet 68180098103 $ 5.75 amoxicillin 250 mg/5 ml oral suspension 00781604146 $ 16.63 loperamide 2 mg capsule 00378210001 $ 5.75 loperamide 2 mg capsule 96295013094 $ 5.75 LORazepam 2 mg/ml oral concentrate 00054353244 $ 120.00 LORazepam 0.5 mg tablet 69315090405 $ 5.75 LORazepam 1 mg tablet 69315090501 $ 5.75 LORazepam 1 mg tablet 00904600861 $ 5.75 ampicillin 250 mg capsule 67253018010 $ 5.75 magnesium citrate oral solution 00904630477 $ 8.21 magnesium oxide 500 mg tablet 00904423960 $ 5.75 medroxyprogesterone 2.5 mg tablet 00555087202 $ 5.75 medroxyprogesterone 2.5 mg tablet 59762374001 $ 5.75 9999999028 $ 42.99 meperidine 50 mg tablet 00054459525 $ 5.75 methocarbamol 750 mg tablet 31722053401 $ 5.75 methotrexate sodium 2.5 mg tablet 68382077501 $ 10.88 methotrexate sodium 2.5 mg tablet 00054855025 $ 14.08 methyldopa 250 mg tablet 16729003001 $ 5.75 methylphenidate 10 mg tablet 31722017401 $ 5.75 metoclopramide 10 mg tablet 00093220301 $ 5.75 metoclopramide 5 mg tablet 00093220401 $ 5.75 metoprolol tartrate 50 mg tablet 00378003201 $ 5.75 metronidazole 500 mg tablet 29300022701 $ 5.75 miconazole nitrate 2 % topical cream 00472073556 $ 5.75 morphine 15 mg immediate release tablet 00054023525 $ 5.75 naproxen 250 mg tablet 65162018810 $ 5.75 naproxen 500 mg tablet 49483061801 $ 5.75 niacin 100 mg tablet 79854020130 $ 5.75 niacin 500 mg tablet 00904227260 $ 5.75 nitroglycerin ER 2.5 mg capsule,extended release 00904064360 $ 5.75 nitroglycerin ER 6.5 mg capsule,extended release 00904064460 $ 5.75 nitroglycerin 0.4 mg sublingual tablet 00071041813 $ 5.75 nitroglycerin 2 % transdermal ointment 00281032608 $ 5.75 nortriptyline 25 mg capsule 51672400201 $ 5.75