AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR

NDC Code HCPCS Code Medication Name & Amount Inpatient Fee 00904525646 J8499 ACETAMINOPHEN 80 MG CHEWABLE TABLET 1.00 00904198261 J3490 ACETAMINOPHEN 325 MG TABLET 1.00 50580050110 J3490 ACETAMINOPHEN 325 MG TABLET 1.00 50580060002 J3490 ACETAMINOPHEN 325 MG TABLET 1.00 50580045110 J8499 ACETAMINOPHEN 500 MG TABLET 1.00 00713011850 J8499 ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY 59.00 00713016450 J8499 ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY 59.00 00713016501 J8499 ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY 59.00 51672402301 J8499 ACETAZOLAMIDE 250 MG TABLET 2.79 39822019001 J1120 ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION 2,244.47 63323069030 J3490 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION 452.06 63323069404 J3490 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION 441.36 99999003179 ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION 302.00 23155001701 J8499 TETRACYCLINE 250 MG CAPSULE 359.97 44206025105 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 2,207.58 44206025190 P9047 ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 2,207.58 13533069020 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION 1,301.40 68516521402 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION 3,612.76 68516521404 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION 4,071.84 13533069021 P9045 ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION 1,301.40 00093066116 J8499 ALBUTEROL SULFATE 2 MG/5 ML SYRUP 1,774.93 Outpatient Fee $ $ 1.00 $ $ 1.00 $ $ 1.00 $ $ 1.00 $ $ 1.00 $ $ 59.00 $ $ 59.00 $ $ 59.00 $ $ 2.79 $ $ 2,244.47 $ $ 452.06 $ $ 441.36 $ $ 302.00 $ $ 359.97 $ $ 2,207.58 $ $ 2,207.58 $ $ 1,301.40 $ $ 3,612.76 $ $ 4,071.84 $ $ 1,301.40 $ $ 1,774.93 17478050305 J3490 ETHANOL (ETHYL ALCOHOL) 98 % INJECTION SOLUTION $ 3,893.40 $ 3,893.40 51079020501 J8499 ALLOPURINOL 100 MG TABLET $ 1.00 $ 1.00 62584071311 J8499 ALLOPURINOL 300 MG TABLET $ 1.00 $ 1.00 00904585861 J8499 ALPRAZOLAM 0.25 MG TABLET $ 59.00 $ 59.00 00904585961 J8499 ALPRAZOLAM 0.5 MG TABLET $ 59.00 $ 59.00 00536009185 ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL J8499 SUSPENSION $ 205.42 $ 205.42 99999003184 ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION $ 59.00 $ 59.00 00832201200 J8499 AMANTADINE HCL 100 MG CAPSULE $ 1.00 $ 1.00 00409592101 J0280 AMINOPHYLLINE 250 MG/10 ML INTRAVENOUS SOLUTION $ 586.99 $ 586.99 51079013101 J8499 AMITRIPTYLINE 10 MG TABLET $ 1.00 $ 1.00 51079010701 J8499 AMITRIPTYLINE 25 MG TABLET $ 1.00 $ 1.00 51079013301 J8499 AMITRIPTYLINE 50 MG TABLET $ 1.00 $ 1.00 39822990001 AMMONIA AROMATIC 15 % (W/V) SOLUTION FOR J3490 INHALATION $ 59.00 $ 59.00 00781202001 J8499 AMOXICILLIN 250 MG CAPSULE $ 59.00 $ 59.00 00093310953 J8499 AMOXICILLIN 500 MG CAPSULE $ 1.00 $ 1.00 00781261301 J8499 AMOXICILLIN 500 MG CAPSULE $ 1.00 $ 1.00 00781603955 J8499 AMOXICILLIN 125 MG/5 ML ORAL SUSPENSION $ 83.84 $ 83.84 67253014847 J8499 AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION $ 281.44 $ 281.44

00781604155 J8499 AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION $ 95.81 $ 95.81 39822105505 J0285 AMPHOTERICIN B 50 MG SOLUTION FOR INJECTION $ 1,533.89 $ 1,533.89 67253018010 J8499 AMPICILLIN 250 MG CAPSULE $ 59.00 $ 59.00 67253018110 J8499 AMPICILLIN 500 MG CAPSULE $ 59.00 $ 59.00 00781214501 J8499 AMPICILLIN 500 MG CAPSULE $ 59.00 $ 59.00 00781340485 J0290 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION $ 302.00 $ 302.00 25021013610 J0290 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION $ 302.00 $ 302.00 55150011310 J0290 AMPICILLIN 1 GRAM SOLUTION FOR INJECTION $ 302.00 $ 302.00 00781340078 J0290 AMPICILLIN 125 MG SOLUTION FOR INJECTION $ 319.96 $ 319.96 25021013720 J0290 AMPICILLIN 2 GRAM SOLUTION FOR INJECTION $ 310.90 $ 310.90 55150011420 J0290 AMPICILLIN 2 GRAM SOLUTION FOR INJECTION $ 302.00 $ 302.00 25021013410 J0290 AMPICILLIN 250 MG SOLUTION FOR INJECTION $ 302.00 $ 302.00 55150011210 J0290 AMPICILLIN 500 MG SOLUTION FOR INJECTION $ 302.00 $ 302.00 00904052260 J8499 ASCORBIC ACID (VITAMIN C) 250 MG TABLET $ 1.00 $ 1.00 00904052361 J8499 ASCORBIC ACID (VITAMIN C) 500 MG TABLET $ 1.00 $ 1.00 66553000201 J8499 ASPIRIN 81 MG CHEWABLE TABLET $ 59.00 $ 59.00 00904628889 J8499 ASPIRIN 81 MG CHEWABLE TABLET $ 59.00 $ 59.00 00904201360 J8499 ASPIRIN 325 MG TABLET,DELAYED RELEASE $ 1.00 $ 1.00 00904770418 J8499 ASPIRIN 81 MG TABLET,DELAYED RELEASE $ 1.00 $ 1.00 00904539261 J8499 ATENOLOL 25 MG TABLET $ 1.00 $ 1.00 62584046711 J8499 ATENOLOL 50 MG TABLET $ 59.00 $ 59.00 00409163010 J0461 ATROPINE 0.1 MG/ML INJECTION SYRINGE $ 180.44 $ 180.44 00409491134 J0461 ATROPINE 0.1 MG/ML INJECTION SYRINGE $ 331.34 $ 331.34 76329333901 J0461 ATROPINE 0.1 MG/ML INJECTION SYRINGE $ 326.55 $ 326.55 00517040125 J0461 ATROPINE 0.4 MG/ML INJECTION SOLUTION $ 150.94 $ 150.94 00641600601 J0461 ATROPINE 0.4 MG/ML INJECTION SOLUTION $ 1,124.15 $ 1,124.15 17478021505 J3490 ATROPINE 1 % EYE DROPS $ 1,934.13 $ 1,934.13 96295011845 J8499 B COMPLEX WITH VITAMIN C TABLET $ 59.00 $ 59.00 00009023344 J3490 BACITRACIN 50,000 UNIT INTRAMUSCULAR SOLUTION $ 371.42 $ 371.42 00574402235 J3490 BACITRACIN 500 UNIT/GRAM EYE OINTMENT $ 3,372.43 $ 3,372.43 00810073088 NEOMYCIN BACITRACN ZN POLYMYX 3.5 MG 400 UNIT J3490 5,000 UNIT/GRAM TOP OINT $ 159.29 $ 159.29 00501379801 BACITRACIN POLYMYXIN B 500 UNIT 10,000 UNIT/GRAM J3490 TOPICAL OINTMENT $ 316.33 $ 316.33 00574402135 BACITRACIN POLYMYXIN B 500 UNIT 10,000 UNIT/GRAM J3490 EYE OINTMENT $ 342.88 $ 342.88 00904647561 J8499 BACLOFEN 10 MG TABLET $ 59.00 $ 59.00 00409397701 WATER FOR INJECTION, BACTERIOSTATIC INJECTION J3490 SOLUTION $ 138.00 $ 138.00 60687011511 J8499 BENZONATATE 100 MG CAPSULE $ 1.00 $ 1.00 00904656460 J8499 BENZONATATE 100 MG CAPSULE $ 1.00 $ 1.00 68084038811 J8499 BENZTROPINE 1 MG TABLET $ 59.00 $ 59.00 00832051289 J8499 BETHANECHOL CHLORIDE 25 MG TABLET $ 1.00 $ 1.00 00713010950 J8499 BISACODYL 10 MG RECTAL SUPPOSITORY $ 59.00 $ 59.00 00713010906 J8499 BISACODYL 10 MG RECTAL SUPPOSITORY $ 59.00 $ 59.00

00409115902 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION J3490 SOLUTION $ 138.00 $ 138.00 00409155918 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION J3490 SOLUTION $ 138.00 $ 138.00 00409115901 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION J3490 SOLUTION $ 138.00 $ 138.00 55150016710 BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION J3490 SOLUTION $ 138.00 $ 138.00 00409116201 J3490 BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION $ 138.00 $ 138.00 00409156019 J3490 BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION $ 143.72 $ 143.72 55150016910 J3490 BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION $ 138.00 $ 138.00 55150017230 BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION J3490 SOLUTION $ 138.00 $ 138.00 37205019573 J8499 CAFFEINE 200 MG TABLET $ 59.00 $ 59.00 00904188361 CALCIUM CARBONATE 500 MG CALCIUM (1,250 MG) J8499 TABLET $ 1.00 $ 1.00 00409163110 CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS J3490 SYRINGE $ 243.52 $ 243.52 76329330401 CALCIUM CHLORIDE 100 MG/ML (10 %) INTRAVENOUS J3490 SYRINGE $ 322.16 $ 322.16 00517390025 CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS J0610 SOLUTION $ 646.71 $ 646.71 63323031119 CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS J0610 SOLUTION $ 295.81 $ 295.81 63323036019 CALCIUM GLUCONATE 100 MG/ML (10 %) INTRAVENOUS J0610 SOLUTION $ 445.51 $ 445.51 00904385461 J8499 CARBAMAZEPINE 100 MG CHEWABLE TABLET $ 59.00 $ 59.00 51672404709 J8499 CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION $ 2,098.09 $ 2,098.09 99999003271 J8499 CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION $ 59.00 $ 59.00 51672400501 J8499 CARBAMAZEPINE 200 MG TABLET $ 1.55 $ 1.55 00904322035 J3490 CARBAMIDE PEROXIDE 6.5 % EAR DROPS $ 138.00 $ 138.00 68084038011 J8499 CARISOPRODOL 350 MG TABLET $ 59.00 $ 59.00 00143992490 J0690 CEFAZOLIN 1 GRAM SOLUTION FOR INJECTION $ 302.00 $ 302.00 60505076900 J0690 CEFAZOLIN 10 GRAM SOLUTION FOR INJECTION $ 660.00 $ 660.00 00781345070 J0690 CEFAZOLIN 500 MG SOLUTION FOR INJECTION $ 302.00 $ 302.00 00143997790 J0697 CEFUROXIME SODIUM 1.5 GRAM INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00143997990 J0697 CEFUROXIME SODIUM 750 MG SOLUTION FOR INJECTION $ 302.00 $ 302.00 00093314501 J8499 CEPHALEXIN 250 MG CAPSULE $ 59.00 $ 59.00 50268015211 J8499 CEPHALEXIN 500 MG CAPSULE $ 59.00 $ 59.00 00395266216 J8499 CHERRY FLAVOR (BULK) SYRUP $ 453.18 $ 453.18 63323047827 CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION J2400 SOLUTION $ 842.32 $ 842.32

00143921001 CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION J2400 SOLUTION $ 593.22 $ 593.22 00143921010 CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJECTION J2400 SOLUTION $ 593.22 $ 593.22 00641139831 J3230 CHLORPROMAZINE 25 MG/ML INJECTION SOLUTION $ 1,155.77 $ 1,155.77 00832030100 J8499 CHLORPROMAZINE 25 MG TABLET $ 4.52 $ 4.52 51079005801 J8499 CHLORTHALIDONE 25 MG TABLET $ 2.39 $ 2.39 63739005910 J8499 CLINDAMYCIN HCL 150 MG CAPSULE $ 59.00 $ 59.00 00009090211 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ 302.00 $ 302.00 00009090218 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ 302.00 $ 302.00 00009077520 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ 302.00 $ 302.00 00009087021 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ 302.00 $ 302.00 47781046570 J3490 CLINDAMYCIN 150 MG/ML INJECTION SOLUTION $ 622.12 $ 622.12 51079029901 J8499 CLONIDINE HCL 0.1 MG TABLET $ 59.00 $ 59.00 00904565661 J8499 CLONIDINE HCL 0.1 MG TABLET $ 59.00 $ 59.00 51079030001 J8499 CLONIDINE HCL 0.2 MG TABLET $ 59.00 $ 59.00 51672200202 J3490 CLOTRIMAZOLE 1 % TOPICAL CREAM $ 124.56 $ 124.56 51672200306 J3490 CLOTRIMAZOLE 1 % VAGINAL CREAM $ 100.60 $ 100.60 66553000101 J8499 ASPIRIN 325 MG TABLET $ 1.00 $ 1.00 00527172874 J3490 COCAINE 4 % TOPICAL SOLUTION $ 7,401.00 $ 7,401.00 00054024425 J8499 CODEINE SULFATE 30 MG TABLET $ 59.00 $ 59.00 64764011907 J8499 COLCHICINE 0.6 MG TABLET $ 8.90 $ 8.90 00517003125 CYANOCOBALAMIN (VIT B 12) 1,000 MCG/ML INJECTION J3420 SOLUTION $ 265.07 $ 265.07 63323004401 CYANOCOBALAMIN (VIT B 12) 1,000 MCG/ML INJECTION J3420 SOLUTION $ 275.85 $ 275.85 51079064401 J8499 CYCLOBENZAPRINE 10 MG TABLET $ 59.00 $ 59.00 24208073501 J3490 CYCLOPENTOLATE 1 % EYE DROPS $ 608.78 $ 608.78 51991083801 J8499 CYPROHEPTADINE 4 MG TABLET $ 59.00 $ 59.00 63739047810 J8499 DOCUSATE SODIUM 100 MG CAPSULE $ 59.00 $ 59.00 49938010230 J8499 DAPSONE 25 MG TABLET $ 133.64 $ 133.64 00054817925 J8540 DEXAMETHASONE 0.5 MG TABLET $ 59.00 $ 59.00 00054817525 J8540 DEXAMETHASONE 4 MG TABLET $ 81.13 $ 81.13 63323051610 J1100 DEXAMETHASONE 10 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641036721 J1100 DEXAMETHASONE 10 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 63323016501 J1100 DEXAMETHASONE 4 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00338002303 DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS J3490 SOLUTION $ 317.00 $ 317.00 00338002304 DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS J3490 SOLUTION $ 319.00 $ 319.00 00409177510 J3490 DEXTROSE 25 % IN WATER (D25W) INTRAVENOUS SYRINGE $ 300.20 $ 300.20 00338001702 J7060 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 00338001703 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ 314.50 $ 314.50

00338001704 J7070 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ 315.00 $ 315.00 00338001731 J7060 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 00338001738 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 00338001741 J7060 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 00338001748 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 00409792225 DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION $ $ 00409712007 DEXTROSE 70 % IN WATER (D70W) INTRAVENOUS J3490 SOLUTION $ 658.04 $ 658.04 51079028401 J8499 DIAZEPAM 2 MG TABLET $ 1.00 $ 1.00 00904588061 J8499 DIAZEPAM 5 MG TABLET $ 1.00 $ 1.00 54162001101 J3490 DIBUCAINE 1 % TOPICAL OINTMENT $ 248.15 $ 248.15 51079011801 J8499 DICYCLOMINE 10 MG CAPSULE $ 59.00 $ 59.00 00054005746 J3490 DIGOXIN 50 MCG/ML ORAL SOLUTION $ 152.63 $ 152.63 68094075159 J3490 DIGOXIN 50 MCG/ML ORAL SOLUTION $ 4.24 $ 4.24 49884049401 J8499 DIGOXIN 250 MCG TABLET $ 2.23 $ 2.23 51079074501 J8499 DILTIAZEM 30 MG TABLET $ 1.00 $ 1.00 51079074601 J8499 DILTIAZEM 60 MG TABLET $ 1.00 $ 1.00 51079074701 J8499 DILTIAZEM 90 MG TABLET $ 1.00 $ 1.00 63323066401 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641037621 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 67457012410 J1200 DIPHENHYDRAMINE 50 MG/ML INJECTION SOLUTION $ 297.81 $ 297.81 00904530661 J8499 DIPHENHYDRAMINE 25 MG CAPSULE $ 1.00 $ 1.00 00904205661 J8499 DIPHENHYDRAMINE 50 MG CAPSULE $ 59.00 $ 59.00 00121048905 J8499 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL ELIXIR $ 109.31 $ 109.31 00054319446 DIPHENOXYLATE ATROPINE 2.5 MG 0.025 MG/5 ML ORAL J8499 LIQUID $ 2,868.76 $ 2,868.76 99999002817 DIPHENOXYLATE ATROPINE 2.5 MG 0.025 MG/5 ML ORAL J8499 LIQUID $ 270.55 $ 270.55 00378041501 J8499 DIPHENOXYLATE ATROPINE 2.5 MG 0.025 MG TABLET $ 59.00 $ 59.00 00536106505 J3490 DOCUSATE CALCIUM 240 MG CAPSULE $ 59.00 $ 59.00 51079043701 J8499 DOXEPIN 25 MG CAPSULE $ 1.00 $ 1.00 25021020751 J9000 DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION $ 209.76 $ 209.76 00703504001 J9000 DOXORUBICIN 2 MG/ML INTRAVENOUS SOLUTION $ 203.80 $ 203.80 63323013011 DOXYCYCLINE HYCLATE 100 MG INTRAVENOUS POWDER J3490 FOR SOLUTION $ 1,151.50 $ 1,151.50 12496120403 BUPRENORPHINE 4 MG NALOXONE 1 MG SUBLINGUAL J3490 FILM $ 351.65 $ 351.65 96295010818 J8499 DOXYLAMINE SUCCINATE 25 MG TABLET $ 59.00 $ 59.00 37205067164 J8499 DOXYLAMINE SUCCINATE 25 MG TABLET $ 59.00 $ 59.00

17478051500 J3490 EPHEDRINE SULFATE 50 MG/ML INJECTION SOLUTION $ 1,234.21 $ 1,234.21 00409490118 J0171 EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE $ 297.41 $ 297.41 00409492134 J0171 EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE $ 163.28 $ 163.28 17478007035 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ 406.45 $ 406.45 00574402450 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ 232.78 $ 232.78 00574402411 J3490 ERYTHROMYCIN 5 MG/GRAM (0.5 %) EYE OINTMENT $ 232.78 $ 232.78 24338013402 ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL J8499 POWDER FOR SUSPENSION $ 9,217.53 $ 9,217.53 00409648201 ERYTHROMYCIN LACTOBIONATE 500 MG INTRAVENOUS J1364 SOLUTION $ 2,849.61 $ 2,849.61 00409909332 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00409909335 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00409909431 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641602901 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ 289.82 $ 289.82 00409909441 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ 339.32 $ 339.32 00409909461 J3010 FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION $ 339.32 $ 339.32 00121053005 FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL J8499 LIQUID $ 2.01 $ 2.01 00245010889 FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED J3490 RELEASE $ 1.00 $ 1.00 51672125302 J3490 FLUOCINONIDE 0.05 % TOPICAL CREAM $ 1,052.70 $ 1,052.70 00378607401 J8499 FLUPHENAZINE 5 MG TABLET $ 59.00 $ 59.00 63323018410 J3490 FOLIC ACID 5 MG/ML INJECTION SOLUTION $ 1,878.40 $ 1,878.40 63739053710 J8499 FOLIC ACID 1 MG TABLET $ 1.00 $ 1.00 00904319760 J8499 FOLIC ACID 400 MCG TABLET $ 1.00 $ 1.00 36000028225 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 36000028325 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 36000028425 J1940 FUROSEMIDE 10 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00904579661 J8499 FUROSEMIDE 20 MG TABLET $ 1.00 $ 1.00 00904579761 J8499 FUROSEMIDE 40 MG TABLET $ 59.00 $ 59.00 51079052701 J8499 FUROSEMIDE 80 MG TABLET $ 1.00 $ 1.00 00904579861 J8499 FUROSEMIDE 80 MG TABLET $ 1.00 $ 1.00 63323001002 J1580 GENTAMICIN 40 MG/ML INJECTION SOLUTION $ 302.00 $ 302.00 63323001020 J1580 GENTAMICIN 40 MG/ML INJECTION SOLUTION $ 940.68 $ 940.68 51079087301 J8499 GLYBURIDE 5 MG TABLET $ 1.00 $ 1.00 00713010209 J8499 GLYCERIN (CHILD) RECTAL SUPPOSITORY $ 59.00 $ 59.00 00132008112 J8499 GLYCERIN (CHILD) RECTAL SUPPOSITORY $ 59.00 $ 59.00 00143968101 J3490 GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION $ 437.85 $ 437.85 00781139213 J8499 HALOPERIDOL 1 MG TABLET $ 59.00 $ 59.00 00781139613 J8499 HALOPERIDOL 5 MG TABLET $ 59.00 $ 59.00 63323047401 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $ 225.39 $ 225.39 25021080601 J1630 HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 59390019205 J3490 HOMATROPINE 5 % EYE DROPS $ 900.60 $ 900.60 63323061401 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ 479.04 $ 479.04

39822050001 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ 359.13 $ 359.13 63323061400 J0360 HYDRALAZINE 20 MG/ML INJECTION SOLUTION $ 479.04 $ 479.04 68084044711 J8499 HYDRALAZINE 10 MG TABLET $ 1.00 $ 1.00 63739012610 J8499 HYDRALAZINE 25 MG TABLET $ 1.00 $ 1.00 63739012710 J8499 HYDRALAZINE 50 MG TABLET $ 1.00 $ 1.00 63739012810 J8499 HYDROCHLOROTHIAZIDE 25 MG TABLET $ 1.00 $ 1.00 00713050312 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY $ 207.07 $ 207.07 59741030112 J8499 HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY $ 192.42 $ 192.42 00409128331 J1170 HYDROMORPHONE 1 MG/ML INJECTION SYRINGE $ 138.00 $ 138.00 00409131230 J1170 HYDROMORPHONE 2 MG/ML INJECTION SYRINGE $ 138.00 $ 138.00 42858030125 J8499 HYDROMORPHONE 2 MG TABLET $ 59.00 $ 59.00 63739027510 J8499 HYDROMORPHONE 2 MG TABLET $ 59.00 $ 59.00 00517560125 J3410 HYDROXYZINE HCL 50 MG/ML INTRAMUSCULAR SOLUTION $ 367.47 $ 367.47 60432015004 J8499 HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION $ 395.69 $ 395.69 68084025311 J8499 HYDROXYZINE HCL 10 MG TABLET $ 1.00 $ 1.00 23155050101 J8499 HYDROXYZINE HCL 25 MG TABLET $ 59.00 $ 59.00 76439030910 J8499 HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET $ 59.00 $ 59.00 63739067210 J8499 IBUPROFEN 400 MG TABLET $ 59.00 $ 59.00 00904585461 J8499 IBUPROFEN 600 MG TABLET $ 59.00 $ 59.00 00904585561 J8499 IBUPROFEN 800 MG TABLET $ 59.00 $ 59.00 00904791461 J8499 IBUPROFEN 200 MG TABLET $ 1.00 $ 1.00 49884005401 J8499 IMIPRAMINE 10 MG TABLET $ 59.00 $ 59.00 49884005501 J8499 IMIPRAMINE 25 MG TABLET $ 1.00 $ 1.00 00378008001 J8499 INDAPAMIDE 2.5 MG TABLET $ 1.00 $ 1.00 51079019001 J8499 INDOMETHACIN 25 MG CAPSULE $ 59.00 $ 59.00 00555007101 J8499 ISONIAZID 300 MG TABLET $ 59.00 $ 59.00 00781155601 J8499 ISOSORBIDE DINITRATE 10 MG TABLET $ 74.03 $ 74.03 49884002201 J8499 ISOSORBIDE DINITRATE 20 MG TABLET $ 83.26 $ 83.26 49884002001 J8499 ISOSORBIDE DINITRATE 5 MG TABLET $ 87.06 $ 87.06 42023011310 J3490 KETAMINE 10 MG/ML INJECTION SOLUTION $ 571.66 $ 571.66 00409205105 J3490 KETAMINE 100 MG/ML INJECTION SOLUTION $ 267.67 $ 267.67 00536673101 J3490 LYSINE 500 MG TABLET $ 1.00 $ 1.00 00074662411 J8499 LEVOTHYROXINE 100 MCG TABLET $ 1.60 $ 1.60 00074706911 J8499 LEVOTHYROXINE 150 MCG TABLET $ 1.58 $ 1.58 00338011704 J7120 LACTATED RINGERS INTRAVENOUS SOLUTION $ 315.00 $ 315.00 00703514001 J0640 LEUCOVORIN CALCIUM 100 MG SOLUTION FOR INJECTION $ 138.00 $ 138.00 00703514501 J0640 LEUCOVORIN CALCIUM 350 MG SOLUTION FOR INJECTION $ 138.00 $ 138.00 00054449613 J8499 LEUCOVORIN CALCIUM 5 MG TABLET $ 59.00 $ 59.00 00074434190 J8499 LEVOTHYROXINE 25 MCG TABLET $ 1.55 $ 1.55 00074455211 J8499 LEVOTHYROXINE 50 MCG TABLET $ 1.58 $ 1.58 00074518211 J8499 LEVOTHYROXINE 75 MCG TABLET $ 1.58 $ 1.58 00054350547 J3490 LIDOCAINE 4 % (40 MG/ML) MUCOSAL SOLUTION $ 1,285.43 $ 1,285.43

63323048457 J3490 LIDOCAINE 5 MG/ML (0.5 %) INJECTION SOLUTION $ 138.00 $ 138.00 00409427501 J3490 LIDOCAINE 5 MG/ML (0.5 %) INJECTION SOLUTION $ 151.70 $ 151.70 00409427601 J3490 LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION $ 138.00 $ 138.00 63323020110 J3490 LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION $ 138.00 $ 138.00 00409427701 J3490 LIDOCAINE 20 MG/ML (2 %) INJECTION SOLUTION $ 138.00 $ 138.00 63323048617 J3490 LIDOCAINE 20 MG/ML (2 %) INJECTION SOLUTION $ 138.00 $ 138.00 68180051501 J8499 LISINOPRIL 20 MG TABLET $ 1.00 $ 1.00 00054252625 J8499 LITHIUM CARBONATE 150 MG CAPSULE $ 59.00 $ 59.00 00054852725 J8499 LITHIUM CARBONATE 300 MG CAPSULE $ 1.00 $ 1.00 00054352763 J8499 LITHIUM CITRATE 8 MEQ/5 ML ORAL SOLUTION $ 129.27 $ 129.27 51079069001 J8499 LOPERAMIDE 2 MG CAPSULE $ 59.00 $ 59.00 50383061810 J8499 LOPERAMIDE 1 MG/5 ML ORAL LIQUID $ 110.73 $ 110.73 63739049910 J8499 LORAZEPAM 0.5 MG TABLET $ 59.00 $ 59.00 51079038601 J8499 LORAZEPAM 1 MG TABLET $ 1.00 $ 1.00 96295038243 J8499 MAGNESIUM CITRATE ORAL SOLUTION $ 59.00 $ 59.00 63323006402 MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION J3475 SOLUTION $ 138.00 $ 138.00 63323006410 MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION J3475 SOLUTION $ 138.00 $ 138.00 00338035703 J3490 MANNITOL 20 % INTRAVENOUS SOLUTION $ 360.50 $ 360.50 00409403101 J2150 MANNITOL 25 % INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00555077902 J8499 MEDROXYPROGESTERONE 10 MG TABLET $ 1.00 $ 1.00 00555087202 J8499 MEDROXYPROGESTERONE 2.5 MG TABLET $ 1.00 $ 1.00 51079043401 J8499 MEGESTROL 20 MG TABLET $ 1.00 $ 1.00 00054355563 J8499 METHADONE 5 MG/5 ML ORAL SOLUTION $ 41.70 $ 41.70 99999003180 J8499 METHADONE 5 MG/5 ML ORAL SOLUTION $ 1.00 $ 1.00 00054855424 J8499 METHADONE 10 MG TABLET $ 1.00 $ 1.00 00054855324 J8499 METHADONE 5 MG TABLET $ 1.00 $ 1.00 00641610325 J2800 METHOCARBAMOL 100 MG/ML INJECTION SOLUTION $ 1,080.64 $ 1,080.64 63739016610 J8499 METHOCARBAMOL 500 MG TABLET $ 1.00 $ 1.00 00703367101 METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION J9260 SOLUTION $ 138.00 $ 138.00 16729027735 METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION J9260 SOLUTION $ 138.00 $ 138.00 16729003001 J8499 METHYLDOPA 250 MG TABLET $ 1.00 $ 1.00 00517037401 METHYLENE BLUE (ANTIDOTE) 5 MG/ML (0.5 %) C9399 INTRAVENOUS SOLUTION $ 6,681.02 $ 6,681.02 00406114201 J8499 METHYLPHENIDATE 5 MG TABLET $ 59.00 $ 59.00 59762444003 J7509 METHYLPREDNISOLONE 4 MG TABLET $ 77.09 $ 77.09 00009347501 METHYLPREDNISOLONE ACETATE 80 MG/ML SUSPENSION J1040 FOR INJECTION $ 539.32 $ 539.32 00409341401 J2765 METOCLOPRAMIDE 5 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00121057616 J8499 METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION $ 1,621.57 $ 1,621.57 00121157610 J8499 METOCLOPRAMIDE 5 MG/5 ML ORAL SOLUTION $ 88.73 $ 88.73 00093220305 J8499 METOCLOPRAMIDE 10 MG TABLET $ 59.00 $ 59.00 51079088601 J8499 METOCLOPRAMIDE 5 MG TABLET $ 1.00 $ 1.00

00409177805 METOPROLOL TARTRATE 5 MG/5 ML INTRAVENOUS J3490 SOLUTION $ 138.00 $ 138.00 00378003210 J8499 METOPROLOL TARTRATE 50 MG TABLET $ 59.00 $ 59.00 29300022601 J8499 METRONIDAZOLE 250 MG TABLET $ 59.00 $ 59.00 42292000101 J8499 METRONIDAZOLE 500 MG TABLET $ 59.00 $ 59.00 68084096611 J8499 METRONIDAZOLE 500 MG TABLET $ 59.00 $ 59.00 00904656861 J8499 METRONIDAZOLE 500 MG TABLET $ 59.00 $ 59.00 68084096601 J8499 METRONIDAZOLE 500 MG TABLET $ 59.00 $ 59.00 00409781137 METRONIDAZOLE 500 MG/100 ML SODIUM CHLORIDE(ISO) J3490 INTRAVENOUS PIGGYBACK $ 302.00 $ 302.00 00603780550 J3490 MICONAZOLE NITRATE 2 % TOPICAL CREAM $ 99.77 $ 99.77 00713025237 J3490 MICONAZOLE NITRATE 2 % VAGINAL CREAM $ 107.79 $ 107.79 00574061816 J3490 MINERAL OIL ORAL $ 269.16 $ 269.16 00132030140 J3490 MINERAL OIL ENEMA $ 132.03 $ 132.03 53489038601 J8499 MINOXIDIL 2.5 MG TABLET $ 1.00 $ 1.00 00641607201 J2270 MORPHINE 15 MG/ML INJECTION SOLUTION $ 295.41 $ 295.41 55150012215 J3490 NAFCILLIN 1 GRAM SOLUTION FOR INJECTION $ 386.63 $ 386.63 44567022110 J3490 NAFCILLIN 1 GRAM SOLUTION FOR INJECTION $ 367.07 $ 367.07 55150012499 J3490 NAFCILLIN 10 GRAM SOLUTION FOR INJECTION $ 2,735.08 $ 2,735.08 00409146501 J2300 NALBUPHINE 20 MG/ML INJECTION SOLUTION $ 223.52 $ 223.52 00409121901 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ 3,229.93 $ 3,229.93 00641613201 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ 342.96 $ 342.96 00641613225 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ 342.96 $ 342.96 00409121501 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ 303.52 $ 303.52 67457029200 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ 899.08 $ 899.08 67457029202 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ 899.08 $ 899.08 17478004101 J2310 NALOXONE 0.4 MG/ML INJECTION SOLUTION $ 324.63 $ 324.63 65162018810 J8499 NAPROXEN 250 MG TABLET $ 59.00 $ 59.00 65162018910 J8499 NAPROXEN 375 MG TABLET $ 59.00 $ 59.00 39822031007 J8499 NEOMYCIN 500 MG TABLET $ 64.06 $ 64.06 00536407001 J8499 NIACIN 50 MG TABLET $ 59.00 $ 59.00 00904227260 J8499 NIACIN 500 MG TABLET $ 59.00 $ 59.00 43386044024 J8499 NIFEDIPINE 10 MG CAPSULE $ 1.00 $ 1.00 51079058401 J8499 NITROFURANTOIN MACROCRYSTAL 50 MG CAPSULE $ 2.88 $ 2.88 00071041813 J8499 NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET $ 1.64 $ 1.64 00281032608 J3490 NITROGLYCERIN 2 % TRANSDERMAL OINTMENT $ 131.67 $ 131.67 51672400105 J8499 NORTRIPTYLINE 10 MG CAPSULE $ 1.00 $ 1.00 68084003211 J8499 NORTRIPTYLINE 25 MG CAPSULE $ 1.00 $ 1.00 00603781874 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM $ 698.21 $ 698.21 00603781878 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM $ 1,047.90 $ 1,047.90 45802005935 J3490 NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM $ 149.70 $ 149.70 60432053760 J3490 NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION $ 261.08 $ 261.08 66689003701 J3490 NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION $ 59.00 $ 59.00 51672126302 NYSTATIN TRIAMCINOLONE 100,000 UNIT/G 0.1 % J3490 TOPICAL CREAM $ 3,629.93 $ 3,629.93 00832003800 J8499 OXYBUTYNIN CHLORIDE 5 MG TABLET $ 1.00 $ 1.00

68084035511 J8499 OXYCODONE ACETAMINOPHEN 5 MG 325 MG TABLET $ 59.00 $ 59.00 00904643761 J8499 OXYCODONE ACETAMINOPHEN 5 MG 325 MG TABLET $ 59.00 $ 59.00 00904571135 J3490 OXYMETAZOLINE 0.05 % NASAL SPRAY $ 59.00 $ 59.00 63323001201 J2590 OXYTOCIN 10 UNIT/ML INJECTION SOLUTION $ 302.00 $ 302.00 42023011601 J2590 OXYTOCIN 10 UNIT/ML INJECTION SOLUTION $ 486.79 $ 486.79 42023011625 J2590 OXYTOCIN 10 UNIT/ML INJECTION SOLUTION $ 302.00 $ 302.00 00049053028 PENICILLIN G POTASSIUM 20 MILLION UNIT SOLUTION FOR J2540 INJECTION $ 1,416.92 $ 1,416.92 00049052084 PENICILLIN G POTASSIUM 5 MILLION UNIT SOLUTION FOR J2540 INJECTION $ 401.36 $ 401.36 00093412773 J8499 PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLUTION $ 155.69 $ 155.69 00093117201 J8499 PENICILLIN V POTASSIUM 250 MG TABLET $ 59.00 $ 59.00 00781165501 J8499 PENICILLIN V POTASSIUM 500 MG TABLET $ 59.00 $ 59.00 51293081001 J8499 PHENAZOPYRIDINE 100 MG TABLET $ 124.57 $ 124.57 75826011510 J8499 PHENAZOPYRIDINE 200 MG TABLET $ 99.31 $ 99.31 00603150858 J8499 PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIXIR $ 2,270.19 $ 2,270.19 63739020110 J8499 PHENOBARBITAL 32.4 MG TABLET $ 1.00 $ 1.00 00603516821 J8499 PHENOBARBITAL 97.2 MG TABLET $ 1.25 $ 1.25 00641047721 PHENOBARBITAL SODIUM 130 MG/ML INJECTION J2560 SOLUTION $ 2,172.97 $ 2,172.97 59212042204 PHENOBARB HYOSCY ATROPINE SCOP 16.2 MG 0.1037 MG J8499 0.0194 MG/5 ML ELIXIR $ 15,605.40 $ 15,605.40 99999000493 PHENOBARB HYOSCY ATROPINE SCOP 16.2 MG 0.1037 MG J8499 0.0194 MG/5 ML ELIXIR $ 667.14 $ 667.14 17478020605 J3490 PHENYLEPHRINE 10 % EYE DROPS $ 1,366.47 $ 1,366.47 17478020102 J3490 PHENYLEPHRINE 2.5 % EYE DROPS $ 1,139.32 $ 1,139.32 00641049321 J1165 PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ 302.00 $ 302.00 00641255541 J1165 PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION $ 302.00 $ 302.00 00071036940 J8499 PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE $ 1.79 $ 1.79 17478051002 J3490 PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION $ 1,562.79 $ 1,562.79 76329124001 PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJECTION J3430 SYRINGE $ 838.16 $ 838.16 61314020315 J3490 PILOCARPINE 1 % EYE DROPS $ 2,953.29 $ 2,953.29 00409818301 J3490 POTASSIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 5020124001 POTASSIUM BICARBONATE CITRIC ACID 25 MEQ J8499 EFFERVESCENT TABLET $ 59.00 $ 59.00 63323096505 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS J3480 SOLUTION $ 138.00 $ 138.00 63323096510 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS J3480 SOLUTION $ 138.00 $ 138.00

63323096520 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS J3480 SOLUTION $ 138.00 $ 138.00 63323096730 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS J3480 SOLUTION $ 138.00 $ 138.00 00409665119 POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS J3480 SOLUTION $ 138.00 $ 138.00 68382070101 POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED J8499 RELEASE $ 1.05 $ 1.05 00121146515 J8499 POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID $ 216.17 $ 216.17 66689004701 J8499 POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQUID $ 440.72 $ 440.72 00409729501 POTASSIUM PHOSPHATES MBASIC AND DIBASIC 3 J3490 MMOL/ML INTRAVENOUS SOLUTION $ 760.44 $ 760.44 51079063001 J8499 PRAZOSIN 1 MG CAPSULE $ 1.58 $ 1.58 51079063101 J8499 PRAZOSIN 2 MG CAPSULE $ 2.18 $ 2.18 61314063705 J3490 PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION $ 1,487.42 $ 1,487.42 00054474125 J7512 PREDNISONE 1 MG TABLET $ 59.00 $ 59.00 00054001720 J7512 PREDNISONE 10 MG TABLET $ 59.00 $ 59.00 00054001820 J7512 PREDNISONE 20 MG TABLET $ 1.00 $ 1.00 00054872425 J7512 PREDNISONE 5 MG TABLET $ 59.00 $ 59.00 00409190301 J2690 PROCAINAMIDE 500 MG/ML INJECTION SOLUTION $ 2,691.65 $ 2,691.65 00093965201 J8597 PROCHLORPERAZINE MALEATE 10 MG TABLET $ 59.00 $ 59.00 51079054101 J8597 PROCHLORPERAZINE MALEATE 5 MG TABLET $ 59.00 $ 59.00 51079054120 J8597 PROCHLORPERAZINE MALEATE 5 MG TABLET $ 59.00 $ 59.00 00641092821 J2550 PROMETHAZINE 25 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641092925 J2550 PROMETHAZINE 50 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641092921 J2550 PROMETHAZINE 50 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 65162074510 J8597 PROMETHAZINE 12.5 MG TABLET $ 59.00 $ 59.00 51079089501 J8597 PROMETHAZINE 25 MG TABLET $ 59.00 $ 59.00 00603158558 J8499 PROMETHAZINE 6.25 MG CODEINE 10 MG/5 ML SYRUP $ 269.16 $ 269.16 99999002815 J8499 PROMETHAZINE 6.25 MG CODEINE 10 MG/5 ML SYRUP $ 59.00 $ 59.00 61314001601 J3490 PROPARACAINE 0.5 % EYE DROPS $ 874.85 $ 874.85 50111046701 J8499 PROPRANOLOL 10 MG TABLET $ 1.00 $ 1.00 00603548321 J8499 PROPRANOLOL 20 MG TABLET $ 1.00 $ 1.00 00603548421 J8499 PROPRANOLOL 40 MG TABLET $ 1.00 $ 1.00 00228234810 J8499 PROPYLTHIOURACIL 50 MG TABLET $ 1.00 $ 1.00 63323022905 J2720 PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION $ 439.92 $ 439.92 63323018001 PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION J3415 SOLUTION $ 740.28 $ 740.28 00536440601 J8499 PYRIDOXINE (VITAMIN B6) 25 MG TABLET $ 1.00 $ 1.00 00904052060 J8499 PYRIDOXINE (VITAMIN B6) 50 MG TABLET $ 1.00 $ 1.00 43598021040 J3490 SILVER SULFADIAZINE 1 % TOPICAL CREAM $ 1,660.68 $ 1,660.68 67877012450 J3490 SILVER SULFADIAZINE 1 % TOPICAL CREAM $ 351.30 $ 351.30 00536102008 J3490 SIMETHICONE 125 MG CHEWABLE TABLET $ 59.00 $ 59.00

00536222075 J8499 SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION $ 69.47 $ 69.47 00395266116 J8499 SIMPLE SYRUP $ 526.58 $ 526.58 00409729973 J3490 SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 76329335201 SODIUM BICARBONATE 8.4 % (1 MEQ/ML) INTRAVENOUS J3490 SYRINGE $ 367.27 $ 367.27 00223172101 J8499 SODIUM BICARBONATE 650 MG TABLET $ 59.00 $ 59.00 08290306500 A4216 SODIUM CHLORIDE 0.9 % INJECTION SYRINGE $ 138.00 $ 138.00 08881570300 A4216 SODIUM CHLORIDE 0.9 % INJECTION SYRINGE $ 138.00 $ 138.00 08290306553 A4216 SODIUM CHLORIDE 0.9 % INJECTION SYRINGE $ 138.00 $ 138.00 92670001210 A4216 SODIUM CHLORIDE 0.9 % INJECTION SYRINGE $ 138.00 $ 138.00 00338004304 J3490 SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION $ 316.00 $ 316.00 00409488803 A4216 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION $ 138.00 $ 138.00 00409488806 A4216 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION $ 138.00 $ 138.00 00409488810 A4216 SODIUM CHLORIDE 0.9 % INJECTION SOLUTION $ 138.00 $ 138.00 63323018730 J7131 SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION $ 189.23 $ 189.23 00409114102 J7131 SODIUM CHLORIDE 4 MEQ/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00487930133 J3490 SODIUM CHLORIDE 0.9 % FOR NEBULIZATION $ 59.00 $ 59.00 00223176001 J8499 SODIUM CHLORIDE 1 GRAM TABLET $ 1.00 $ 1.00 17478062312 J3490 SODIUM CHLORIDE 5 % EYE DROPS $ 357.49 $ 357.49 63323017005 SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS J3490 SOLUTION $ 520.96 $ 520.96 00409739172 SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS J3490 SOLUTION $ 581.44 $ 581.44 60267070550 SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) J3490 INTRAVENOUS SOLUTION $ 482.38 $ 482.38 46287050030 J8499 SORBITOL 70 % SOLUTION $ 59.00 $ 59.00 00338029547 J3490 SORBITOL 3 % IRRIGATION SOLUTION $ 332.00 $ 332.00 00904595161 J8499 SPIRONOLACTONE 25 MG TABLET $ 1.00 $ 1.00 68084020611 J8499 SPIRONOLACTONE 25 MG TABLET $ 1.00 $ 1.00 00338000347 A4217 WATER FOR IRRIGATION, STERILE SOLUTION $ 323.00 $ 323.00 00338000403 A4217 WATER FOR IRRIGATION, STERILE SOLUTION $ 314.50 $ 314.50 00338000405 A4217 WATER FOR IRRIGATION, STERILE SOLUTION $ 317.00 $ 317.00 39822070602 J3000 STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION $ 3,018.88 $ 3,018.88 00409662902 SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION J0330 SOLUTION $ 686.63 $ 686.63 00781300970 SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION J0330 SOLUTION $ 1,203.99 $ 1,203.99 00703951401 SULFAMETHOXAZOLE 400 MG TRIMETHOPRIM 80 MG/5 J3490 ML INTRAVENOUS SOLUTION $ 633.69 $ 633.69 00703952601 SULFAMETHOXAZOLE 400 MG TRIMETHOPRIM 80 MG/5 J3490 ML INTRAVENOUS SOLUTION $ 1,543.07 $ 1,543.07 53746027101 SULFAMETHOXAZOLE 400 MG TRIMETHOPRIM 80 MG J8499 TABLET $ 59.00 $ 59.00

59762500001 J8499 SULFASALAZINE 500 MG TABLET $ 1.00 $ 1.00 00378014491 J8499 TAMOXIFEN 10 MG TABLET $ 1.00 $ 1.00 51079041801 J8499 TEMAZEPAM 15 MG CAPSULE $ 1.00 $ 1.00 00009041701 TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR J1071 OIL $ 358.09 $ 358.09 23155001801 J8499 TETRACYCLINE 500 MG CAPSULE $ 719.94 $ 719.94 00225052547 J3490 SODIUM CHLORIDE ALOE VERA NASAL GEL $ 117.65 $ 117.65 27808003301 J3490 THEOPHYLLINE 80 MG/15 ML ORAL SOLUTION $ 2,058.16 $ 2,058.16 63323001302 THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION J3411 SOLUTION $ 496.53 $ 496.53 58160089841 FLU VACCINE QS 2018 19(6 MOS UP)(PF)60 MCG(15 90686 MCGX4)/0.5 ML IM SYRINGE $ 652.30 $ 652.30 63323030602 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ 348.19 $ 348.19 63323030630 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ 1,277.20 $ 1,277.20 67457047300 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ 302.00 $ 302.00 17478011430 J3260 TOBRAMYCIN 40 MG/ML INJECTION SOLUTION $ 1,010.14 $ 1,010.14 24208029005 J3490 TOBRAMYCIN 0.3 % EYE DROPS $ 131.74 $ 131.74 50111043401 J8499 TRAZODONE 100 MG TABLET $ 59.00 $ 59.00 50111043301 J8499 TRAZODONE 50 MG TABLET $ 1.00 $ 1.00 00168000315 J3490 TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM $ 82.04 $ 82.04 00168000380 J3490 TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM $ 194.81 $ 194.81 67877025115 J3490 TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM $ 85.63 $ 85.63 67877025180 J3490 TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM $ 198.01 $ 198.01 00003029305 TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR J3301 INJECTION $ 352.90 $ 352.90 60505265601 TRIAMTERENE 37.5 MG HYDROCHLOROTHIAZIDE 25 MG J8499 TABLET $ 1.00 $ 1.00 59762371803 J8499 TRIAZOLAM 0.25 MG TABLET $ 88.59 $ 88.59 00781103401 J8499 TRIFLUOPERAZINE 5 MG TABLET $ 80.64 $ 80.64 16571016010 J8499 TRIHEXYPHENIDYL 2 MG TABLET $ 1.00 $ 1.00 42023011925 TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR J3250 SOLUTION $ 1,214.61 $ 1,214.61 00409653301 J3370 VANCOMYCIN 1,000 MG INTRAVENOUS INJECTION $ 302.00 $ 302.00 00409433201 J3370 VANCOMYCIN 500 MG INTRAVENOUS SOLUTION $ 302.00 $ 302.00 67457034105 J3370 VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION $ 4,438.87 $ 4,438.87 00409650901 J3370 VANCOMYCIN 5 GRAM INTRAVENOUS SOLUTION $ 838.48 $ 838.48 51754020304 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION $ 866.83 $ 866.83 51754020301 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION $ 866.83 $ 866.83 00409114405 J3490 VERAPAMIL 2.5 MG/ML INTRAVENOUS SOLUTION $ 1,073.77 $ 1,073.77 23155005901 J8499 VERAPAMIL 40 MG TABLET $ 1.00 $ 1.00 00904292061 J8499 VERAPAMIL 80 MG TABLET $ 1.00 $ 1.00 63323027810 J9360 VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION $ 220.22 $ 220.22 61703030906 J9370 VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00904208560 J8499 VITAMIN A 10,000 UNIT CAPSULE $ 1.00 $ 1.00 30768003268 J8499 VITAMIN E 400 UNIT CAPSULE $ 1.00 $ 1.00

00056017001 J8499 WARFARIN 2 MG TABLET $ 1.00 $ 1.00 00056017601 J8499 WARFARIN 2.5 MG TABLET $ 1.00 $ 1.00 00056017201 J8499 WARFARIN 5 MG TABLET $ 59.00 $ 59.00 00056017301 J8499 WARFARIN 7.5 MG TABLET $ 1.00 $ 1.00 68084037211 J8499 ACETAMINOPHEN 300 MG CODEINE 30 MG TABLET $ 59.00 $ 59.00 00904578961 J8499 ACYCLOVIR 200 MG CAPSULE $ 59.00 $ 59.00 50268006111 J8499 ACYCLOVIR 400 MG TABLET $ 59.00 $ 59.00 00009316901 J0270 ALPROSTADIL 500 MCG/ML INJECTION SOLUTION $ 4,330.77 $ 4,330.77 00009316906 J0270 ALPROSTADIL 500 MCG/ML INJECTION SOLUTION $ 4,330.77 $ 4,330.77 63323061609 J0282 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION $ 302.00 $ 302.00 67457015300 J0282 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION $ 302.00 $ 302.00 00143987501 J0282 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION $ 302.00 $ 302.00 67457015399 J0282 AMIODARONE 50 MG/ML INTRAVENOUS SOLUTION $ 354.69 $ 354.69 51079062001 J7500 AZATHIOPRINE 50 MG TABLET $ 1.00 $ 1.00 63323013610 J9040 BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION $ 1,262.43 $ 1,262.43 00409141204 J3490 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641600801 J3490 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641600810 J3490 BUMETANIDE 0.25 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00093423201 J8499 BUMETANIDE 0.5 MG TABLET $ 1.22 $ 1.22 00185012901 J8499 BUMETANIDE 1 MG TABLET $ 1.00 $ 1.00 00409361301 BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % J3490 DEXTROSE INJECTION $ 138.00 $ 138.00 00781105301 J8499 BUPROPION HCL 75 MG TABLET $ 1.00 $ 1.00 51079098601 J8499 BUSPIRONE 10 MG TABLET $ 1.00 $ 1.00 51079098501 J8499 BUSPIRONE 5 MG TABLET $ 1.00 $ 1.00 00409162601 J0595 BUTORPHANOL TARTRATE 2 MG/ML INJECTION SOLUTION $ 175.25 $ 175.25 23155011803 J8499 CALCITRIOL 0.25 MCG CAPSULE $ 1.00 $ 1.00 51079086301 J8499 CAPTOPRIL 12.5 MG TABLET $ 76.17 $ 76.17 51079086401 J8499 CAPTOPRIL 25 MG TABLET $ 1.62 $ 1.62 62756051788 J8499 CARBIDOPA 10 MG LEVODOPA 100 MG TABLET $ 59.00 $ 59.00 63739004710 J8499 CARBIDOPA 25 MG LEVODOPA 100 MG TABLET $ 1.00 $ 1.00 68180018001 J8499 CEFADROXIL 500 MG CAPSULE $ 59.00 $ 59.00 00143993101 J0698 CEFOTAXIME 1 GRAM SOLUTION FOR INJECTION $ 302.00 $ 302.00 00143993501 J0698 CEFOTAXIME 10 GRAM SOLUTION FOR INJECTION $ 1,493.57 $ 1,493.57 00143993001 J0698 CEFOTAXIME 500 MG SOLUTION FOR INJECTION $ 302.00 $ 302.00 25021010910 J0694 CEFOXITIN 1 GRAM INTRAVENOUS SOLUTION $ 325.99 $ 325.99 25021011020 J0694 CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION $ 472.98 $ 472.98 44567024625 J0694 CEFOXITIN 2 GRAM INTRAVENOUS SOLUTION $ 442.44 $ 442.44 49884046564 CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR J8499 SUSP IN A PACKET $ 111.09 $ 111.09 44567051001 J9060 CISPLATIN 1 MG/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00009337501 CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE J3490 INTRAVENOUS PIGGYBACK $ 432.50 $ 432.50 00009338201 CLINDAMYCIN 900 MG/50 ML IN 5 % DEXTROSE J3490 INTRAVENOUS PIGGYBACK $ 488.38 $ 488.38 63739026310 J8499 CLONAZEPAM 0.5 MG TABLET $ 59.00 $ 59.00

00904610261 J8499 CLONAZEPAM 1 MG TABLET $ 1.00 $ 1.00 60505013400 J7502 CYCLOSPORINE 100 MG CAPSULE $ 312.35 $ 312.35 60505013300 J7515 CYCLOSPORINE 25 MG CAPSULE $ 116.06 $ 116.06 62756052940 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION $ 6,818.10 $ 6,818.10 55566220000 J2597 DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION $ 1,913.29 $ 1,913.29 17478093705 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ 302.00 $ 302.00 17478093725 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ 548.26 $ 548.26 00641601501 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ 456.45 $ 456.45 17478093710 J3490 DILTIAZEM 5 MG/ML INTRAVENOUS SOLUTION $ 302.00 $ 302.00 51079095801 J8499 DOXAZOSIN 2 MG TABLET $ 144.37 $ 144.37 49884072703 J3490 DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE $ 69.45 $ 69.45 68180065208 J3490 DOXYCYCLINE MONOHYDRATE 100 MG CAPSULE $ 59.00 $ 59.00 00904550261 J8499 ENALAPRIL MALEATE 5 MG TABLET $ 1.00 $ 1.00 64679092602 J8499 ENALAPRIL MALEATE 20 MG TABLET $ 1.00 $ 1.00 00143978701 J3490 ENALAPRILAT 1.25 MG/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00555088602 J8499 ESTRADIOL 1 MG TABLET $ 1.00 $ 1.00 68850001201 J8499 ETHAMBUTOL 400 MG TABLET $ 59.00 $ 59.00 00703565301 J9181 ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00703565601 J9181 ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION $ 174.80 $ 174.80 63739064510 J8499 FAMOTIDINE 20 MG TABLET $ 1.00 $ 1.00 51079096601 J8499 FAMOTIDINE 20 MG TABLET $ 1.00 $ 1.00 65162064210 J8499 FLECAINIDE 100 MG TABLET $ 1.00 $ 1.00 65162064110 J8499 FLECAINIDE 50 MG TABLET $ 1.00 $ 1.00 00115703301 J8499 FLUDROCORTISONE 0.1 MG TABLET $ 59.00 $ 59.00 31722090301 J8499 FLUOXETINE 10 MG CAPSULE $ 1.00 $ 1.00 00781282210 J8499 FLUOXETINE 20 MG CAPSULE $ 1.00 $ 1.00 00121472105 J8499 FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLUTION $ 5.76 $ 5.76 24208031425 J3490 FLURBIPROFEN 0.03 % EYE DROPS $ 126.55 $ 126.55 51079081001 J8499 GLIPIZIDE 5 MG TABLET $ 1.00 $ 1.00 00904515460 J3490 GUAIFENESIN 200 MG TABLET $ 59.00 $ 59.00 00378116001 J8499 GUANFACINE 1 MG TABLET $ 59.00 $ 59.00 25021040001 J1644 HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION $ 138.00 $ 138.00 25021040010 J1644 HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION $ 138.00 $ 138.00 25021040301 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ 138.00 $ 138.00 25021040304 J1644 HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION $ 211.90 $ 211.90 62559013807 J8499 HYDROCORTISONE 100 MG/60 ML ENEMA $ 235.89 $ 235.89 42858030301 J3490 HYDROMORPHONE 8 MG TABLET $ 59.00 $ 59.00 68084026911 J8499 HYDROXYCHLOROQUINE 200 MG TABLET $ 1.97 $ 1.97 49884072401 J8499 HYDROXYUREA 500 MG CAPSULE $ 1.00 $ 1.00 68094060059 J3490 IBUPROFEN 100 MG/5 ML ORAL SUSPENSION $ 59.75 $ 59.75 51672129802 J3490 KETOCONAZOLE 2 % TOPICAL CREAM $ 1,211.98 $ 1,211.98 25021070102 J1885 KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION $ 138.00 $ 138.00

00409379619 J1885 KETOROLAC 60 MG/2 ML INTRAMUSCULAR SOLUTION $ 138.00 $ 138.00 00093031401 J8499 KETOROLAC 10 MG TABLET $ 73.13 $ 73.13 17478042020 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00409226720 J3490 LABETALOL 5 MG/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00904592861 J8499 LABETALOL 100 MG TABLET $ 1.00 $ 1.00 24208050505 J3490 LEVOBUNOLOL 0.5 % EYE DROPS $ 186.43 $ 186.43 00074659490 J8499 LEVOTHYROXINE 88 MCG TABLET $ 1.55 $ 1.55 00074929690 J8499 LEVOTHYROXINE 112 MCG TABLET $ 79.08 $ 79.08 63739034910 J8499 LISINOPRIL 10 MG TABLET $ 1.00 $ 1.00 68180051301 J8499 LISINOPRIL 5 MG TABLET $ 1.00 $ 1.00 68084024811 J8499 LORATADINE 10 MG TABLET $ 59.00 $ 59.00 68084024801 J8499 LORATADINE 10 MG TABLET $ 59.00 $ 59.00 00409677802 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 76329826101 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION $ 487.03 $ 487.03 00641604425 J2060 LORAZEPAM 2 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 68585000698 MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) J8499 TABLET $ 59.00 $ 59.00 25021020110 J9209 MESNA 100 MG/ML INTRAVENOUS SOLUTION $ 138.00 $ 138.00 00904632661 J8499 METFORMIN 500 MG TABLET $ 1.00 $ 1.00 23155007101 J8499 METHIMAZOLE 10 MG TABLET $ 1.00 $ 1.00 23155007001 J8499 METHIMAZOLE 5 MG TABLET $ 1.00 $ 1.00 63323041112 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 63323041125 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641605901 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 00641605910 J2250 MIDAZOLAM 1 MG/ML INJECTION SOLUTION $ 138.00 $ 138.00 43386016006 J8499 MISOPROSTOL 100 MCG TABLET $ 1.00 $ 1.00 16729011638 J9280 MITOMYCIN 40 MG INTRAVENOUS SOLUTION $ 42,433.13 $ 42,433.13 00406800330 MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) J8499 ORAL SOLUTION $ 252.70 $ 252.70 76282025705 J8499 NABUMETONE 500 MG TABLET $ 59.00 $ 59.00 00536100294 J3490 TETRAHYDROZOLINE 0.05 % EYE DROPS $ 59.00 $ 59.00 00409337504 NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS J3490 SOLUTION $ 857.80 $ 857.80 66689002530 J8499 OXYCODONE 20 MG/ML ORAL CONCENTRATE $ 9,998.15 $ 9,998.15 00406055223 J8499 OXYCODONE 5 MG TABLET $ 59.00 $ 59.00 00904644461 J8499 OXYCODONE 5 MG TABLET $ 59.00 $ 59.00 59923060110 J2430 PAMIDRONATE 30 MG INTRAVENOUS SOLUTION $ 501.16 $ 501.16 00472024260 J3490 PERMETHRIN 5 % TOPICAL CREAM $ 1,755.69 $ 1,755.69 63736012002 J3490 PERMETHRIN 1 % TOPICAL LIQUID $ 402.76 $ 402.76 00409707514 POTASSIUM CHLORIDE 10 MEQ/50 ML IN STERILE WATER J3480 INTRAVENOUS PIGGYBACK $ 302.00 $ 302.00 00409707526 POTASSIUM CHLORIDE 20 MEQ/100ML IN STERILE WATER J3480 INTRAVENOUS PIGGYBACK $ 302.00 $ 302.00 63739044710 POTASSIUM CHLORIDE ER 20 MEQ TABLET,EXTENDED J8499 RELEASE(PART/CRYST) $ 1.00 $ 1.00 50383004224 J7510 PREDNISOLONE 15 MG/5 ML ORAL SOLUTION $ 362.03 $ 362.03

99999000748 J7510 PREDNISOLONE 15 MG/5 ML ORAL SOLUTION $ 59.00 $ 59.00 50383004004 PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 J7510 MG/5 ML) ORAL SOLN $ 2,589.02 $ 2,589.02 00527130101 J8499 PRIMIDONE 50 MG TABLET $ 1.00 $ 1.00 00713013512 J8499 PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY $ 231.10 $ 231.10 00713052606 J8499 PROMETHAZINE 25 MG RECTAL SUPPOSITORY $ 240.04 $ 240.04 00409469924 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION $ 347.31 $ 347.31 25021060820 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION $ 138.00 $ 138.00 00409469933 J2704 PROPOFOL 10 MG/ML INTRAVENOUS EMULSION $ 171.66 $ 171.66 00115351101 J8499 PYRIDOSTIGMINE BROMIDE 60 MG TABLET $ 1.31 $ 1.31 68180065806 J8499 RIFAMPIN 150 MG CAPSULE $ 59.00 $ 59.00 00338004746 J3490 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION $ 321.00 $ 321.00 00338004747 J3490 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION $ 314.00 $ 314.00 00338004802 J3490 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION $ $ 00338004803 J3490 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION $ 314.50 $ 314.50 00338004804 J3490 SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION $ 314.00 $ 314.00 60505008000 J8499 SOTALOL 80 MG TABLET $ 1.00 $ 1.00 53746051501 J8499 SPIRONOLACTONE 100 MG TABLET $ 1.00 $ 1.00 51079075301 J8499 SUCRALFATE 1 GRAM TABLET $ 1.00 $ 1.00 61314022705 J3490 TIMOLOL MALEATE 0.5 % EYE DROPS $ 125.35 $ 125.35 39822041201 J3260 TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION $ 2,600.39 $ 2,600.39 61314004475 J3490 TRIFLURIDINE 1 % EYE DROPS $ 6,385.61 $ 6,385.61 24208031510 POLYMYXIN B SULFATE 10,000 UNIT TRIMETHOPRIM 1 J3490 MG/ML EYE DROPS $ 162.48 $ 162.48 50268079611 J8499 URSODIOL 300 MG CAPSULE $ 6.48 $ 6.48 00056016901 J8499 WARFARIN 1 MG TABLET $ 1.00 $ 1.00 53489014601 SULFAMETHOXAZOLE 800 MG TRIMETHOPRIM 160 MG J8499 TABLET $ 59.00 $ 59.00 63739022810 SULFAMETHOXAZOLE 800 MG TRIMETHOPRIM 160 MG J8499 TABLET $ 59.00 $ 59.00 00904110231 J3490 POVIDONE IODINE 10 % TOPICAL OINTMENT $ 59.00 $ 59.00 00536101701 J8499 MECLIZINE 12.5 MG TABLET $ 59.00 $ 59.00 59746012106 J8499 MECLIZINE 25 MG TABLET $ 1.00 $ 1.00 00904651761 J8499 MECLIZINE 25 MG TABLET $ 1.00 $ 1.00 66758011006 POTASSIUM CHLORIDE ER 8 MEQ TABLET,EXTENDED J3490 RELEASE $ 1.00 $ 1.00 00555089902 J8499 ESTRADIOL 0.5 MG TABLET $ 1.00 $ 1.00 00603082354 J8499 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID $ 59.00 $ 59.00 00536077097 J8499 DIPHENHYDRAMINE 12.5 MG/5 ML ORAL LIQUID $ 59.00 $ 59.00 00487980101 IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR J3490 INHALATION $ 59.00 $ 59.00 76204010030 IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR J3490 INHALATION $ 59.00 $ 59.00 68180051201 J8499 LISINOPRIL 2.5 MG TABLET $ 1.00 $ 1.00 51079089401 J8499 VERAPAMIL ER (SR) 120 MG TABLET,EXTENDED RELEASE $ 2.02 $ 2.02 00904643459 J8499 SENNOSIDES 8.6 MG TABLET $ 59.00 $ 59.00

00904652261 J8499 SENNOSIDES 8.6 MG TABLET $ 59.00 $ 59.00 00536002583 ALUMINUM MAG HYDROXIDE SIMETHICONE 200 MG 200 J3490 MG 20 MG/5 ML ORAL SUSP $ 59.00 $ 59.00 00121176130 ALUMINUM MAG HYDROXIDE SIMETHICONE 200 MG 200 J3490 MG 20 MG/5 ML ORAL SUSP $ 85.03 $ 85.03 57664060088 ISOSORBIDE DINITRATE ER 40 MG TABLET,EXTENDED J8499 RELEASE $ 81.67 $ 81.67 68084050311 PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED J8499 RELEASE $ 2.78 $ 2.78 51991081801 PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED J8499 RELEASE $ 1.47 $ 1.47 51079067001 J8610 METHOTREXATE SODIUM 2.5 MG TABLET $ 2.82 $ 2.82 00904640761 J8499 BISACODYL 5 MG TABLET,DELAYED RELEASE $ 59.00 $ 59.00 24338010213 J8499 ERYTHROMYCIN 250 MG TABLET $ 350.55 $ 350.55 00904588761 THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12 J8499 HR $ 59.00 $ 59.00 50111048301 THEOPHYLLINE ER 100 MG TABLET,EXTENDED RELEASE,12 J8499 HR $ 59.00 $ 59.00 00121174410 J8499 GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ 59.00 $ 59.00 00121148810 J8499 GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ 59.00 $ 59.00 00121148800 J8499 GUAIFENESIN 100 MG/5 ML ORAL LIQUID $ 59.00 $ 59.00 00168011109 J3490 BACITRACIN ZINC 500 UNIT/GRAM TOPICAL PACKET $ 1.00 $ 1.00 45802043803 J3490 HYDROCORTISONE 1 % TOPICAL CREAM $ 59.00 $ 59.00 00904386575 J3490 SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL $ 59.00 $ 59.00 00536355101 J8499 CYANOCOBALAMIN (VIT B 12) 500 MCG TABLET $ 1.00 $ 1.00 51079093601 J8499 TERAZOSIN 1 MG CAPSULE $ 1.00 $ 1.00 51079093701 J8499 TERAZOSIN 2 MG CAPSULE $ 1.00 $ 1.00 51079093801 J8499 TERAZOSIN 5 MG CAPSULE $ 1.00 $ 1.00 51079089901 J8499 VERAPAMIL ER (SR) 180 MG TABLET,EXTENDED RELEASE $ 2.17 $ 2.17 63739067110 J8499 TRAMADOL 50 MG TABLET $ 59.00 $ 59.00 00904632761 J8499 METFORMIN 850 MG TABLET $ 1.00 $ 1.00 53746021901 J8499 METFORMIN 850 MG TABLET $ 1.00 $ 1.00 57664050389 J8499 TIZANIDINE 4 MG TABLET $ 59.00 $ 59.00 00409710709 POTASSIUM CHLORIDE 20 MEQ/L IN D5 0.9 % SODIUM J3490 CHLORIDE INTRAVENOUS $ 313.00 $ 313.00 00409710909 POTASSIUM CHLORIDE 40 MEQ/L IN D5 0.9 % SODIUM J3490 CHLORIDE INTRAVENOUS $ 313.00 $ 313.00 00409799309 POTASSIUM CHLORIDE 10 MEQ/L IN DEXTROSE 5 % 0.45 % J3490 SODIUM CHLORIDE IV $ 313.00 $ 313.00 00409790109 POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 % 0.2 % J3490 SODIUM CHLORIDE IV $ 313.00 $ 313.00 00409790103 POTASSIUM CHLORIDE 20 MEQ/L IN DEXTROSE 5 % 0.2 % SODIUM CHLORIDE IV $ 313.50 $ 313.50 00409790209 J3490 D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION $ 313.00 $ 313.00 00409790203 J3490 D5 / 0.45% NACL W KCL 20 MEQ/L IV SOLUTION $ 313.00 $ 313.00

00409790309 POTASSIUM CHLORIDE 30 MEQ/L IN DEXTROSE 5 % 0.45 % J3490 SODIUM CHLORIDE IV $ 313.00 $ 313.00 00409790409 POTASSIUM CHLORIDE 40 MEQ/L IN DEXTROSE 5 % 0.45 % J3490 SODIUM CHLORIDE IV $ 313.00 $ 313.00 63323048157 LIDOCAINE EPINEPHRINE 0.5 % 1:200,000 INJECTION J3490 SOLUTION $ 138.00 $ 138.00 00409790509 POTASSIUM CHLORIDE 20 MEQ/L IN 5 % DEXTROSE J3490 INTRAVENOUS SOLUTION $ 313.00 $ 313.00 00121059530 SODIUM CITRATE CITRIC ACID 500 MG 334 MG/5 ML ORAL J8499 SOLUTION $ 1.34 $ 1.34 00641601901 J2274 MORPHINE (PF) 1 MG/ML INJECTION SOLUTION $ 652.70 $ 652.70 00338104902 NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % J3490 DEXTROSE INTRAVENOUS $ 698.60 $ 698.60 00338008503 DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE J3490 INTRAVENOUS SOLUTION $ 315.50 $ 315.50 00338008504 DEXTROSE 5 % AND 0.45 % SODIUM CHLORIDE J3490 INTRAVENOUS SOLUTION $ 316.00 $ 316.00 00338007703 DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION $ 315.00 $ 315.00 00338007704 DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE J3490 INTRAVENOUS SOLUTION $ 317.00 $ 317.00 00338008903 DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE J7042 INTRAVENOUS SOLUTION $ 399.00 $ 399.00 00338008904 DEXTROSE 5 % AND 0.9 % SODIUM CHLORIDE J7042 INTRAVENOUS SOLUTION $ 316.00 $ 316.00 00409318201 LIDOCAINE 20 MG/ML (2 %) EPINEPHRINE 1:100,000 J3490 INJECTION SOLUTION $ 138.00 $ 138.00 00409317801 LIDOCAINE 1 % EPINEPHRINE 1:100,000 INJECTION J3490 SOLUTION $ 138.00 $ 138.00 63323048837 LIDOCAINE EPINEPHRINE (PF) 1.5 % 1:200,000 INJECTION J3490 SOLUTION $ 213.18 $ 213.18 00338107502 DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % J1250 DEXTROSE IV $ 1,397.20 $ 1,397.20 63323048927 LIDOCAINE EPINEPHRINE (PF) 2 % 1:200,000 INJECTION J3490 SOLUTION $ 211.58 $ 211.58 66689069479 J8499 METHADONE 10 MG/ML ORAL CONCENTRATE $ 1,417.01 $ 1,417.01 99999003183 J8499 METHADONE 10 MG/ML ORAL CONCENTRATE $ 59.00 $ 59.00 00338012504 DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS J3490 SOLUTION $ 315.00 $ 315.00 57565006310 J3490 GLUCOSE 4 GRAM CHEWABLE TABLET $ 85.18 $ 85.18 00409711509 POTASSIUM CHLORIDE 20 MEQ/L IN 0.9 % SODIUM J3480 CHLORIDE INTRAVENOUS $ 313.00 $ 313.00 00409711609 POTASSIUM CHLORIDE 40 MEQ/L IN 0.9 % SODIUM J3490 CHLORIDE INTRAVENOUS $ 313.00 $ 313.00 66553000401 CALCIUM CARBONATE 200 MG CALCIUM (500 MG) J8499 CHEWABLE TABLET $ 1.00 $ 1.00 61703032322 J9040 BLEOMYCIN 30 UNIT SOLUTION FOR INJECTION $ 3,550.65 $ 3,550.65