Similar documents
1.877.ICS 行 政 辦 公 室 Independence Care System 257 Park Ave. South 2nd Floor New York, NY 會 員 中 心 400 East Fordham Road 10th fl

Empire FIDA Plan 2015 年 承 保 藥 物 清 單 ( 處 方 集 ) 此 為 Empire BlueCross BlueShield HealthPlus Fully Integrated Duals Advantage (FIDA) Plan 參 與 者 可 獲 取 的 藥

2016_Formulary_Best_005_ENG.pdf

給 藥 途 徑 優 點 缺 點 口 服 最 簡 易 方 便 給 藥 方 式 藥 物 血 中 濃 度 可 維 持 穩 定 作 用 較 慢 長 效 劑 型 不 可 磨 粉 不 適 用 於 有 腸 胃 功 能 障 礙 如 腸 阻 塞 嘔 吐 的 患 者, 有 服 藥 順 從 性 之 問 題 舌 下 錠 直

Microsoft Word drugbulletin.doc

untitled

(Microsoft Word - \262\304168\246\270\274f\304\263\267|-\244W\272\364\244\275\247i\252\251-new2.doc)

NY List of Covered Drugs 2016_TCH

修 订 概 要 序 号 修 订 处 修 订 内 容 1 文 件 ( 第 四 版 ) 附 件 2 抗 菌 药 物 处 方 权 限 级 别 表, 新 增 内 科 的 处 方 权 限 名 单 内 科 新 增 处 方 权 限 名 单 : 具 有 限 制 使 用 级 抗 菌 药 物 处 方 权 的 医 师 :

智力测试故事

LIP 2016 ANOC-EOC Chinese

30,000,000 75,000,000 75,000, (i) (ii) (iii) (iv)

<4D F736F F D C4EAB9FABCD2BBF9B1BED2A9CEEFC4BFC2BCB3F6CCA82DBBF9D2A9CAD0B3A1B4F3C0A9C8DDA3ACB6C0BCD2C6B7D6D6BCB0D6D0D2A9D7A2C9E4BCC1B5AFD0D4B4F3>

non-asa jr tab 160mg 3 $0 NM; * non-aspirin chw 80mg 3 $0 NM; * pain relief dro 80/0.8ml 3 $0 NM; * pain relief liq 500/15ml 3 $0 NM; * pain relief su

Default - California - Chinese

I-. 泌 尿 外 科 分 册

Microsoft Word - John_Ch_1202

奇闻怪录

加 拿 大 防 癌 協 會 謹 此 向 約 克 大 學 (York University) 瑪 嘉 烈 醫 院 (Princess Margaret Hospital) 大 學 健 康 網 絡 (University Health Network) 和 多 倫 多 大 學 (University o

施 的 年 度 維 修 工 程 已 於 4 月 15 日 完 成, 並 於 4 月 16 日 重 新 開 放 給 市 民 使 用 ii. 天 水 圍 游 泳 池 的 年 度 維 修 工 程 已 於 3 月 31 日 完 成, 並 於 4 月 1 日 重 新 開 放 給 市 民 使 用 iii. 元

Microsoft Word - 藥物安全簡訊vol 25-final.doc

歡 迎 您 成 為 滙 豐 銀 聯 雙 幣 信 用 卡 持 卡 人 滙 豐 銀 聯 雙 幣 信 用 卡 同 時 兼 備 港 幣 及 人 民 幣 戶 口, 讓 您 的 中 港 消 費 均 可 以 當 地 貨 幣 結 算, 靈 活 方 便 此 外, 您 更 可 憑 卡 於 全 球 近 400 萬 家 特

H2751_NY030536_MMP_FOR_CHI_FINAL_08_NY_06_15_PREFACE.indd

2015年廉政公署民意調查

簡 介 第 1 節 關 於 ALIGNMENT HEALTH PLAN CALPLUS (HMO) 的 重 要 資 訊

電 話 一 通, 我 們 即 在! 如 果 您 準 備 投 保 或 有 投 保 方 面 的 疑 問, 請 致 電 , 每 週 7 天, 早 上 8 點 至 晚 上 8 點 提 供 服 務 Connecticut: WellCare Value (HMO)

Microsoft Word - Entry-Level Occupational Competencies for TCM in Canada200910_ch _2_.doc


我国服装行业企业社会责任问题的探讨.pages

Microsoft Word - COC HKROO App I _Chi_ Jan2012.doc

科技人與過勞死系列三 科技人逃生密訣

Pain [

<4D F736F F D205B345DB5D8AE4CACD AECAAFC5C1C9C1DCBDD0AB48A4CEB3F8A657AAED>

Microsoft Word - Final Chi-Report _PlanD-KlnEast_V7_ES_.doc

, Current as of 7/1/16 H1916_FC FIDA 您 可 以 通 過 其 他 語 言 免 費 獲 取 該 信 息 週 一 至 週 五 上 午 8 點 至 晚 8 點, 撥 打 或 該 電

对联故事

WATER SOLUBLE POWDER

1099 医 科 学 院 广 安 门 医 院 南 区 也 随 之 开 展 全 院 抗 菌 药 物 临 床 应 用 专 项 整 治 活 动, 提 高 抗 菌 药 物 临 床 合 理 应 用 水 平 对 年 门 诊 抗 菌 药 物 的 使 用 情 况 进 行 分 析, 为 抗 菌 药

實 用 資 訊 保 戶 服 務 部 ( 免 費 ) 非 急 診 交 通 運 輸 醫 療 交 通 運 輸 管 理 部 聽 力 障 礙 者 服 務 專 線 (TTY) 紐 約 州 傳 譯 服 務 地 址 Aetna Better He

2016_Formulary_Access_020_CHI

二 白 色 念 珠 菌 感 染 白 色 念 珠 菌 是 一 種 依 賴 肝 醣 維 生 的 黴 菌, 造 成 感 染 的 原 因 有 :1. 因 懷 孕 時 雌 激 素 濃 度 上 升, 使 陰 道 上 皮 細 胞 內 所 含 的 肝 醣 增 加 所 致 2. 服 用 口 服 避 孕 藥 或 長 期

僑光技術學院通識教育中心


全民健康保險藥事小組第6屆第20次會議紀錄

<4D F736F F D20BB4FAA46BFA4B2C4A447B4C15F D313038A67E5FBAEEA658B56FAE69B9EAAC49A4E8AED72D5FAED6A977A5BB5F >

Painkyl_ _

Microsoft Word doc

財 務 委 員 會 審 核 2014 至 2015 年 度 開 支 預 算 的 報 告 2014 年 7 月

II II

目 錄 壹 藥 名 / 規 格... 1 貳 用 法 用 量... 1 參 臨 床 用 途... 8 肆 副 作 用 / 不 良 反 應... 9 伍 藥 物 交 互 作 用 陸 懷 孕 用 藥 / 哺 乳 用 藥 柒 藥 物 安 定 性 / 貯 存 方 式 捌

(b) 3 (a) (b) 7 (a) (i) (ii) (iii) (iv) (v) (vi) (vii) 57

<D6D0B9FAB9C5CAB757512E6D7073>

電 話 一 通, 我 們 即 在! Connecticut: Florida: Georgia: WellCare Access (HMO SNP) WellCare Access Libe

Microsoft PowerPoint - Pain Control Guideline.ppt

<4D F736F F D20B6ABD0CBD6A4C8AFB9C9B7DDD3D0CFDEB9ABCBBECAD7B4CEB9ABBFAAB7A2D0D0B9C9C6B1D5D0B9C9CBB5C3F7CAE9A3A8C9EAB1A8B8E C4EA33D4C23131C8D5B1A8CBCDA3A92E646F63>

<D2A9C6B D6B528D0C2B0E6A3A92E786C73>

我 非 常 希 望 该 小 组 的 建 议 尤 其 是 其 执 行 摘 要 能 受 到 将 于 2000 年 9 月 来 纽 约 参 加 千 年 首 脑 会 议 的 所 有 领 导 人 的 注 意 这 次 历 史 性 的 高 级 别 会 议 提 供 了 一 个 独 特 的 机 会 使 我 们 能 够

Applications

第 二 輯 目 錄.indd 2 目 錄 編 寫 說 明 附 : 香 港 中 學 文 憑 中 國 語 文 科 評 核 模 式 概 述 綜 合 能 力 考 核 考 試 簡 介 及 應 試 技 巧 常 用 實 用 文 文 體 格 式 及 寫 作 技 巧 綜 合 能 力 分 項 等 級 描 述 練 習 一

衛 生 福 利 部 國 民 健 康 署 醫 療 院 所 戒 菸 服 務 補 助 計 畫 作 業 須 知 目 錄 壹 前 言...01 貳 如 何 申 請 辦 理 戒 菸 服 務...02 一 申 請 資 格 二 提 出 申 請 三 簽 訂 契 約 參 如 何 提

一、

擔 費 用 外, 另 可 額 外 申 請 三 項 新 增 給 付 項 目 ( 即 套 裝 給 付 ), 分 別 是 : 1. E4003C 結 核 病 接 觸 者 檢 查 衛 教 諮 詢 及 抽 血 100 點 2. E4004C 丙 型 干 擾 素 釋 放 詴 驗 IGRA 檢 驗 ( 不 含 詴

会员手册 - Members - AmeriHealth Caritas Northeast

2 亞 裔 親 屬 照 顧 者 手 冊 亞 裔 親 屬 照 顧 者 計 劃 (AFCP) 乃 是 紐 約 市 以 色 列 醫 院 疼 痛 治 療 及 紓 緩 部 隆 重 鳴 謝 以 下 各 位, 為 幫 助 亞 裔 親 屬 照 顧 者 計 劃 的 發 展 和 實 施 勞 心 勞 力, 以 他 們 豐

「保險中介人資格考試」手冊

<B2FAC6B7C4BFC2BC43452E786C73>

兒 童 會 4 摩 爾 門 經 本 教 材 專 為 8-11 歲 的 兒 童 設 計 耶 穌 基 督 後 期 聖 徒 教 會 台 北 發 行 中 心 印 行

Microsoft Word - MP2018_Report_Chi _12Apr2012_.doc

南華大學數位論文

李天命的思考藝術

皮肤病防治.doc

性病防治

中国南北特色风味名菜 _一）

(Microsoft Word - LE PETIT PRINCE\244\244\244\345\252\251.doc)

172Maz封面

文件編號：HA /2012

《小王子》 （法）圣埃克苏佩里 原著

第 三 十 六 期 與 良 好 基 礎 上, 以 堅 定 不 移 的 步 伐, 群 策 群 力 向 前 邁 進, 實 現 本 局 以 實 證 基 礎 及 社 會 成 本 為 衡 量 準 則, 期 能 經 濟 有 效 理 及 防 物 濫 用 的 組 織 願 景 2 世 界 衛 生 組 織 防 毒 注

Microsoft PowerPoint 物質濫用病人護理.ppt [相容模式]

2. 我 沒 有 說 實 話, 因 為 我 的 鞋 子 其 實 是 [ 黑 色 / 藍 色 / 其 他 顏 色.]. 如 果 我 說 我 現 在 是 坐 著 的, 我 說 的 是 實 話 嗎? [ 我 說 的 對 還 是 不 對 ]? [ 等 對 方 回 答 ] 3. 這 是 [ 實 話 / 對 的

簡 介 一 宗 旨 本 討 論 會 擬 經 由 制 度 法 規 臨 床 實 務 實 證 醫 學 案 例 剖 析 等 面 向 之 探 討, 強 化 病 人 安 全, 提 升 醫 療 品 質, 紓 解 醫 療 爭 議, 建 置 優 質 安 全 之 醫 療 環 境 二 目 的 本 次 討 論 會 以 藥

「保險中介人資格考試」手冊

(i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x) (i) (ii)(iii) (iv) (v)

捕捉儿童敏感期

山东出版传媒招股说明书

急診常見疾病及處理

- 2 - 获 豁 免 计 算 入 总 楼 面 面 积 及 / 或 上 盖 面 积 的 环 保 及 创 新 设 施 根 据 建 筑 物 条 例 的 规 定 4. 以 下 的 环 保 设 施 如 符 合 某 些 条 件, 并 由 有 关 人 士 提 出 豁 免 申 请, 则 可 获 豁 免 计 算 入

绝妙故事

<4D F736F F D203938BEC7A67EABD7B942B0CAC15AC075B3E6BF57A9DBA5CDC2B2B3B92DA5BFBD542E646F63>

Microsoft PowerPoint - 小兒用藥 ppt [相容模式]

榫 卯 是 什 麼? 何 時 開 始 應 用 於 建 築 中? 38 中 國 傳 統 建 築 的 屋 頂 有 哪 幾 種 形 式? 40 大 內 高 手 的 大 內 指 什 麼? 42 街 坊 四 鄰 的 坊 和 街 分 別 指 什 麼? 44 北 京 四 合 院 的 典 型 格 局 是 怎 樣 的

Transcription:

CENTERS PLAN FOR HEALTHY LIVING 中央計劃管理式長期護理護士服務 CENTERS PLAN ADVANTAGE CARE (HMO) CENTERS PLAN CARE COMPLETE (MMP) Centers Plan for FIDA Care Complete Medicare-Medicaid計劃 2016年承保藥物清單 處方一覽表 本處方一覽表更新於7/1/2016 如果您有任何疑問 請致電Centers Plan for FIDA Care Complete 電話是1-888-266-7460 每週七天 每天早8點至晚8點 TTY使用者請致電1-800-421-1220 此電話 免費 We CARE... about your CARE H3018_16702_CY2016_Drug_List_CH

Centers Plan for FIDA Care Complete (Medicare-Medicaid 計劃 ) 2016 年承保藥物清單 本處方一覽表更新於 1/7/2016 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, 每週七天, 每天早 8 點至晚 8 點 TTY 使用者請致電 1-800-421-1220 此電話免費 更多資訊, 請瀏覽 www.centersplan.com/fida/participants 生效日期.. 2016 年 1 月 1 日最後更新 :1/7/2016 處方一覽表 ID:16507, 第 16 版本 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants iii

如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants iv

Centers Plan for FIDA Care Complete 2016 年承保藥物清單 ( 處方一覽表 ) 這是會員透過 Centers Plan for FIDA Care Complete 可獲得的一份藥物清單 Centers Plan for FIDA Care Complete (Medicare-Medicaid 計劃 ) 是由 Medicare 與紐約州衛生部 (Medicaid) 共同簽署的一份統籌保健計劃, 旨在透過 Fully Integrated Duals Advantage (FIDA) 計劃展示為會員同時提供 Medicare 和 Medicaid 的福利 承保藥物清單及 / 或藥店和醫療提供者網絡在全年內可能發生變化 在我們做出影響到您的修改之前, 我們將 向您傳送通知 福利可能在每年的 1 月 1 日發生變化 您可隨時線上檢視 Centers Plan for FIDA Care Complete 的最新承保藥物清單, 網址為 www.centersplan.com/fida/participants, 或者致電 Centers Plan for FIDA Care Complete 會員服務部, 電話是 1-888-266-7460 限制和約束可能適用 有關詳細諮詢, 請致電 Centers Plan for FIDA Care Complete 會員服務部, 或閱讀 Centers Plan for FIDA Care Complete 會員手冊 任何承保藥物無自付費用 您可以其他格式 ( 大字型印刷 布拉耶點字法或音訊 ) 免費獲得此資訊 請在我們的工作時間內致電 1-888-266-7460,TTY/TDD 使用者可致電 1-800-421-1220, 我們的工作時間是 : 每週 7 天 每天早 8 點至晚 8 點 此電話免費 You can get this information for free in other languages. Call 1-888-266-7460, and TTY/TDD users call 1-800-421-1220, during our hours of operation: 8 am to 8pm, seven days a week. The call is free. 您可以免費獲得我們用其他語言提供的該資訊 請在我們的工作時間內致電 1-888-266-7460,TTY/TDD 使用者可致電 1-800-421-1220, 我們的工作時間是 : 每週 7 天 每天早 8 點至晚 8 點 致電是免費的 Ou ka jwenn enfòmasyon sa a gratis nan lòt lang yo. Rele 1-888-266-7460, e itilizatè TTY/TDD yo ka rele 1-800-421-1220, pandan lè fonksyonman: 8 am a 8pm, sèt jou pa semèn. Apèl la gratis. Queste informazioni sono disponibili gratuitamente in altre lingue. Chiamare x il numero 1-888-266-7460 e 1-800-421-1220 per gli utenti TTY/TDD negli orari di lavoro: dalle 08:00 alle 20:00, 7 giorni su 7. La chiamata è gratuita. 이정보를다른언어로무료로받아보실수있습니다. 1-888-266-7460번으로전화주시고, TTY/TDD 사용자들은 1-800-421-1220번으로영업시간동안전화주십시오 : 오전 8시 ~ 오후 8시, 매주 7일간본전화료는무료입니다 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants v

Вы можете получить эту информацию бесплатно на других языках. Звоните по номеру 1-888-266-7460, пользователи телетайпа/текстового телефона по номеру 1-800-421-1220, во время наших часов работы: 08:00 20:00, семь дней в неделю. Звонок является бесплатным. Puede obtener esta información en otros idiomas de manera gratuita. Llame al 1-888-266-7460, y los usuarios de TTY/TDD pueden llamar al 1-800-421-1220, durante nuestras horas de operación: 8 a.m. a 8 p.m., los siete días de la semana. La llamada es gratuita. The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by Centers Plan for FIDA Care Complete. ICAN may be reached toll-free at 1-844-614-8800 or online at icannys.org. 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants vi

常見問題 (FAQ) 如果您對於承保藥物清單有任何疑問, 請在此尋找答案 您可以閱讀所有常見問題 (FAQ) 以瞭解更多資訊, 或 尋找一個問題和答案 1. 承保藥物清單上包含哪些處方藥? ( 我們將承保藥物清單簡稱為藥物清單 ) 承保藥物清單 3 頁開始所列的各藥物為 Centers Plan for FIDA Care Complete 承保藥物 這些藥物均可在我們網 絡藥房內獲得 如果藥房與我們簽訂合作協定並向您提供服務, 則藥房在我們網絡內 我們把這些藥房稱為 網絡藥房 Centers Plan for FIDA Care Complete 將承保藥物清單上的所有藥物, 如果 : 您的醫生或其他開藥醫生表示您需要這些藥物以康復或維持健康, 藥物對治療您的病症具有醫療必要性, 以及 您在 Centers Plan for FIDA Care Complete 網絡藥房內配藥 Centers Plan for FIDA Care Complete 可能在獲得某些藥物上需要採取其他步驟 ( 請檢視以下第 5 個問題 ) 在一些情況下, 您在獲得藥物之前可能需要做其他事, 例如先嘗試其他藥物 查看最新承保藥物清單, 您可瀏覽我們網站 www.centersplan.com/fida/participants 或致電會員服務部, 電話是 1-888-266-7460 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants vii

2. 藥物清單是否會變更? 是 一年當中 Centers Plan for FIDA Care Complete 可能會新增或移除藥物清單中的某些藥物 通常, 只有在以下情況下藥物清單會有所變更 : 現在出現了一種新藥物, 其藥效與藥物清單上的藥物效果相同, 或者 我們瞭解到一種藥物並不安全 我們可能也會變更我們的藥物規則 例如, 我們可以 : 決定一種藥物是否需要事先核准 ( 事先核准是指在您可獲得藥物之前, 您需獲得 Centers Plan for FIDA Care Complete 或您的跨學科小組 (IDT) 的許可 ) 新增或變更您可獲得的藥量 ( 稱為 數量限制 ) 增加或變更藥物逐步治療限制 ( 逐步治療指在我們會承保其他藥物之前, 您必須先試用其他藥物 ) ( 有關這些藥物規則的更多資訊, 請參閱第 ix 頁 ) 一旦您正在服用的藥物從藥物清單上除名, 我們將告知您 一旦我們變更藥物的承保規則, 我們將告知您 以下第 3 4 以及 7 個問題就藥物清單變更會發生什麼的問題有更多闡述 您可總是線上查看 Centers Plan for FIDA Care Complete 的最新藥物清單, 網址是 www.centersplan.com/fida/participants 您可致電會員服務部, 瞭解現行版本的藥物清單, 電話是 1-888-266-7460 3. 如果現在出現了一種與藥物清單上藥物效果相同且價格更低的新藥, 會發生什麼? 如果現出現了一種與藥物清單上藥物效果相同的新藥 : 您的藥劑師可能在您下次配藥時向您提供較便宜的藥物 如果您和您的提供者認定便宜的藥物對您並不適用, 您的提供者可讓藥劑師繼續向您提供您正在服用的藥物 Centers Plan for FIDA Care Complete 可能決定將較貴的藥物從藥物清單上移除 如果我們因為新藥具有相同藥效而將您在服用的一種藥物從藥物清單上移除, 我們將在藥物從藥物清單上移除前至少 60 天前或在您要求續配藥時通知您 隨後您可在藥物清單變更前購買 60 天的藥 如果我們決定將一種藥物從藥物清單上移除, 我們將在藥物從藥物清單上移除前至少 60 天以書面形式以及 / 或者電話方式通知您 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants viii

4. 如果我們發現一種藥物並不安全, 會發生什麼? 如果食品和藥品管理局 (FDA) 表示您服用的藥物並不安全, 我們會立即將此藥從藥物清單上移除 我們亦將發函通知您這種不安全的藥物已從藥物清單上移除 在接收此信函以及 / 或者電話後, 請致電您的醫生並且請他或她開立一種替代藥 5. 藥物承保是否有約束或限制? 或者為取得某些藥品是否要求採取一些措施? 是, 一些藥物有承保規則或限制您所能取得的藥量 一些情況下, 您 您的醫生或其他開藥醫生在取得藥物之前必須先做某件事情 例如 : 事先核准 ( 或事先核准 ): 對於一些藥品, 您或您的醫生或其他開藥醫生必須在您配藥之前獲得 Centers Plan for FIDA Care Complete 或您的跨學科小組 (IDT) 的核准 若您未獲得核准,Centers Plan for FIDA Care Complete 可能不承保此藥品 數量限制 : 有時,Centers Plan for FIDA Care Complete 限制您能獲得的藥量 階段治療 : 有時 Centers Plan for FIDA Care Complete 要求您採取逐步治療 這意味著在應對您的醫療病症時, 您將必須按一定順序試用藥物 在我們會承保其他藥物之前, 您可能需要先試用其他藥物 如果您的醫生認為第一種藥物對您並不適用, 之後我們將承保第二種藥物 瞭解您的藥物是否有其他額外要求或限制, 您可從 xvi 頁開始查看各表格 您亦可透過瀏覽我們網站瞭解更多資訊, 網址為 www.centersplan.com/fida/participants 我們發佈線上文件, 解釋我們的事先核准和逐步治療限制 您也可以要求我們向您傳送一份副本 您可對這些限制要求進行 例外處理 瞭解例外處理的更多資訊, 請查看第 11 個問題 如果您在護理設施或其他長期護理設施內, 並且需要藥物清單外的一種藥物, 或者如果您取得所需藥物並不方便, 我們可提供協助 我們將承保一次 31 天急救藥物用量 ( 除非您處方箋上註明的天數較少 ), 不論您是否為 Centers Plan for FIDA Care Complete 新會員 這將給您與您的醫生或其他開藥醫生商討留出時間 他或她可説明您決定是否採用藥物清單上的相似藥或是否需要要求例外處理 瞭解例外處理的更多資訊, 請查看第 11 個問題 6. 您將如何得知您想要的藥物是否有限制或取得藥物是否需要採取行動? 第 18 頁的承保藥物清單有一張柱狀圖, 標題是 必要行動 約束或使用限制 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants ix

7. 如果我們變更了藥物承保方式的規則, 會發生什麼? 例如, 如果我們增加了一種藥物的事先核准 ( 核准 ) 數量限制 以及 / 或者逐步治療 我將向您告知如果我們增加藥物的事先核准 數量限制, 以及 / 或者逐步治療限制 我們將在增加限制或在您要 求下次續配藥之前至少提前 60 天通知您 隨後您可在藥物清單變更前購買 60 天的藥 這將給您與您的醫生或其 他開藥醫生商討下一步操作的時間 8. 您如何在藥品清單上尋找一種藥物? 尋找藥物有兩個方法 : 您可按字母尋找 ( 如果您知道藥物名稱如何拼字 ), 或者 您可按醫療病症查詢 按字母查詢, 請翻至 I-1 頁檢視字母清單部分 然後在清單上尋找您的藥物的名稱 按醫療病症查詢, 請翻至第 18 頁查看 按醫療病症排列藥物清單 這一小節中的藥品根據它們用於治療的醫療狀況類型劃分為不同種類 例如, 如果您心臟有問題, 您應該尋找心血管藥物類別 您可在那裏找到應對心臟問題的藥物 9. 如果您想服用的藥品未在藥物清單上, 該怎麼辦? 如果您在藥物清單上並未看到您的藥物, 請致電 1-888-266-7460, 連絡會員服務部詢問情況 如果您瞭解到 Centers Plan for FIDA Care Complete 將不會對藥物進行承保, 您可採取以下一項操作 : 向會員服務部索取一份您想要服用的藥物清單 然後將清單給您的醫生或其他開藥醫生看 他或她可向您開立類似您想要服用且在藥物清單上的藥物 或 您可要求計劃或您的跨學科小組 (IDT) 作例外處理, 承保您的藥物 瞭解例外處理的更多資訊, 請查看第 11 個問題 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants x

10. 如果您新加入 Centers Plan for FIDA Care Complete, 並且在藥物清單上找不到或很難找到您的藥物, 您該怎麼辦? 我們竭誠相助 我們必須按需要承保在您成為 Centers Plan for FIDA Care Complete 會員最初 90 天的藥物暫時用 量 這將給您與您的醫生或其他開藥醫生商討留出時間 他或她可説明您決定是否採用藥物清單上的相似藥或是否需要要求例外處理 我們將向您承保最多 90 天的暫時藥物用量, 如果 : 您在服用的藥物並不在我們的藥物清單上, 或者 健康計劃規則並不能讓您獲得您的開藥醫生開立的藥量, 或者 藥物需要 Centers Plan for FIDA Care Complete 或您的跨學科小組 (IDT) 事先核准, 或者 您所服用的藥物為逐步治療限制的一部分 如果您在護理設施或其他長期護理設施內, 您可獲得的再次配藥藥量為至多 98 天 在您的計劃的最初 90 天期間, 您可以多次續配藥 這給予您的開藥醫生留出時間將您的藥物改為藥物清單上的藥物或者要求例外處理 如果下列一個護理等級變更情況適用於您, 您可能有資格獲得您目前正在服用的藥物的過渡用量 : 如果您從醫院或其他機構轉到長期護理機構 如果您離開長期護理機構回家 如果您出院回家 如果您從專業護理機構出院 如果您的狀態從安寧照護變為非安寧照護 如果您從精神病院出院並且具有個性化藥物計劃 以上所列的護理等級變更只是您可能有資格獲得過渡用量的一些原因, 有關更多資訊, 請連絡會員服務 部, 電話為 1-888-266-7460 TTY 使用者請致電 1-800-421-1220 代表工作時間為每週七天, 早 8 點至晚 8 點 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants xi

11. 您是否能夠要求例外處理以承保您的藥物? 是 您可要求 Centers Plan for FIDA Care Complete 或您的跨學科小組 (IDT) 作例外處理, 承保未在藥物清單上的藥物 您亦可要求 Centers Plan for FIDA Care Complete 或您的跨學科小組 (IDT) 變更藥物規則 例如,Centers Plan for FIDA Care Complete 可能限制了我們將承保的藥物劑量 如果您的藥物有限制, 您可要求我們或您的 IDT 變更限制或承保更多劑量 其他範例 : 您可要求我們或您的跨學科小組 (IDT) 擯棄逐步治療限制或事先核准要求 12. 獲得例外處理需要多少時間? 首先,Centers Plan for FIDA Care Complete 或您的跨學科小組 (IDT) 必須收到來自您的開藥醫生支援您例外處理要求的聲明 您將在我們收到聲明後 72 小時內獲得我們對於您的例外處理要求的決定 如果您或您的開藥醫生認為如果 72 小時的必須等待可能有損您的健康, 您可要求加快例外處理 這就是快速決定 如果您的開藥醫生支援您的要求, 您將在我們收到您的開藥醫生的支援性聲明後 24 小時內獲得決定 13. 您如何要求進行例外處理? 要求例外處理, 您可致電您的保健管理員 您的保健管理員將協助您和您的提供者協助您要求例外處理 14. 什麼是普通藥物? 普通藥物成分與品牌藥物相同 它們通常比品牌藥價格更低且藥名並不被熟知 普通藥獲食品與藥品管理局 (FDA) 核准 Centers Plan for FIDA Care Complete 承保品牌藥品和普通藥品 15. 什麼是非處方 (OTC) 藥物? OTC 表示 非處方藥 當非處方藥是由您的提供者開立時,Centers Plan for FIDA Care Complete 將承保這些非處方藥 您可閱讀 Centers Plan for FIDA Care Complete 藥物清單, 瞭解哪些非處方藥在承保之列 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants xii

16. Centers Plan for FIDA Care Complete 是否承保非處方藥非藥劑產品? 當非處方非藥劑產品是由您的提供者開立時,Centers Plan for FIDA Care Complete 將承保這些產品 非處方非 藥劑產品包括諸如酒精棉簽和紗布墊等物品 您可閱讀 Centers Plan for FIDA Care Complete 藥物清單, 瞭解哪些非處方非藥劑產品在承保之列 Centers Plan for FIDA Care Complete 同樣為會員提供每個月 $25 的補充非處方藥 (OTC) 福利, 以用於 Medicare 和 Medicaid 不承保的非處方藥清單上的項目 當月未用完的餘額不可轉入下個月 請參閱 會員手冊 第 4 章瞭解更多資訊, 或者致電會員服務部 :1-800-466-2745(TTY 使用者請致電 1-800-421-1220), 工作時間是每週 7 天, 每天早 8 點至晚 8 點 17. 什麼是您的自付費用? 藥物清單上的藥物您無需支付自付費用 18. 什麼是藥物層級? 層級就是藥物組 所有計劃藥物清單上的藥物均為四 (4) 層級之一 您無需支付任一一層的藥物費用 第 1 層級為 Medicare 承保的普通藥物 這是最低一級 第 2 層級為 Medicare 承保的品牌藥物和專用藥物 第 3 層級為 Medicaid 承保的非 D 部分藥物 第 4 層級為 Medicaid 承保的非處方 (OTC) 藥 這是最高一級 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants xiii

承保藥物清單 18 頁開始的承保藥物清單向您提供 Centers Plan for FIDA Care Complete 承保的藥物資訊 如果您在藥物清單上找藥物有困難, 請翻至 I-1 頁, 開始閱讀索引部分 圖示第一柱列出了藥物名稱 品牌藥名稱大寫 ( 如 :NORTHERA), 普通藥為斜體小寫 ( 如 :clonidine) 必要行動 約束或使用限制柱狀圖向您說明您藥物的 Centers Plan for FIDA Care Complete 承保規則 文件文字部分可能會有以下使用管理縮寫承保註釋縮寫 縮寫說明解釋 使用管理約束 PA PA-HRM PA NSO 事前核准約束事前核准約束用於 B 部分及 D 部分判定 B 部分及 D 部分判定的高危藥品 B 部分及 D 部分判定的僅限於紐約州 在您獲得此藥配藥之前, 您 ( 或者您的醫生 ) 必須首先獲得 Centers Plan for FIDA Care Complete 的事前核准 若您未獲得核准,Centers Plan for FIDA Care Complete 可能不承保此藥品 在 Medicare B 部分或者 D 部分承保下, 該藥物可能符合支付資格 您 ( 或您的醫生 ) 必須在您獲得此藥配藥之前取得 Centers Plan for FIDA Care Complete 關於此藥在 Medicare D 部分承保下的事先核准 若您未獲得核准,Centers Plan for FIDA Care Complete 可能不承保此藥品 本藥品已經被 CMS 視為潛在有害藥品, 因此針對 Medicare65 周歲及以上受益者是高危藥品 65 周歲或以上參與者必須在您獲得此藥配藥之前首先獲得 Centers Plan for FIDA Care Complete 的事前核准 若您未獲得核准,Centers Plan for FIDA Care Complete 可能不承保此藥品 如果您是名新參與者或者如果您之前未曾服用過此藥, 您 ( 或您的醫生 ) 必須在您為此藥配藥之前獲得 Centers Plan for FIDA Care Complete 的事先核准 若您未獲得核准,Centers Plan for FIDA Care Complete 可能不承保此藥品 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants xiv

縮寫說明解釋 QL ST 數量限制約束 逐步治療約束 Centers Plan for FIDA Care Complete 限制每份處方或某指定期間所承保的藥量 在 Centers Plan for FIDA Care Complete 將為此藥提供承保之前, 您必須首先使用其他藥物以應對您的醫療病症 只有當其他藥物對您並不起作用的情況下, 此藥才可能獲得承保 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants xv

文件文字部分可能會有以下承保註釋縮寫 其他特殊承保要求 縮寫說明解釋 LA NM 獲得管道有限的藥物 非來信訂購藥品 該處方可能只能在一些藥房配藥 欲瞭解更多訊息, 請參閱您的 藥房名錄 或致電會員服務部 : 1-888-266-7460, 工作時間為每週七天, 早 8 點至晚 8 點 TTY/TDD 使用者應致電 1-800-421-1220 您可能在您的處方表中按折扣藥品分擔費用郵購多數藥品的 1 個月以上供給量 透過郵購福利無法獲得的藥品在您處方一覽表中的要求 / 限制一欄中以 NM 標註 * 不是 D 部分藥物 這種藥是一份非 D 部分藥物或一份非處方藥物或產品 注意 : 藥品邊上的 (*) 表示此藥並非 D 部分藥品 這些藥品有不同的上訴規則 上訴即要求我們審核並且在您認為存在錯誤的情況下變更承保決定的正式方式 例如,Centers Plan for FIDA Care Complete 或您的跨學科小組 (IDT) 可能決定您想要的藥物並未或不再受到 Medicare or Medicaid 承保 如果您或您的醫生或其他開藥醫生對該決定有異議, 您可提起上訴 瞭解如何上訴的指令, 請致電會員服務部, 電話是 1-888-266-7460 或者致電獨立消費者宣導組織 (ICAN), 電話是 1-844-614-8800 您亦可閱讀會員手冊, 瞭解如何對決定提起上訴 如果您有任何疑問, 請致電 Centers Plan for FIDA Care Complete, 電話是 1-888-266-7460, (TTY/TDD www.centersplan.com/fida/participants xvi

Table of Contents Analgesics... 3 Anesthetics... 13 Anti-Addiction/Substance Abuse Treatment Agents... 14 Antianxiety Agents... 16 Antibacterials... 16 Anticancer Agents... 28 Anticholinergic Agents... 37 Anticonvulsants... 37 Antidementia Agents... 41 Antidepressants... 42 Antidiabetic Agents... 45 Antifungals... 49 Antihistamines... 53 Anti-Infectives (Skin And Mucous Membrane)... 59 Antimigraine Agents... 59 Antimycobacterials... 60 Antinausea Agents... 61 Antiparasite Agents... 62 Antiparkinsonian Agents... 63 Antipsychotic Agents... 65 Antivirals (Systemic)... 68 Blood Products/Modifiers/Volume Expanders... 74 Caloric Agents... 78 www.centersplan.com/fida/participants 1

Cardiovascular Agents... 83 Central Nervous System Agents... 97 Contraceptives... 99 Cough And Cold Products... 107 Dental And Oral Agents... 117 Dermatological Agents... 118 Devices... 126 Disinfectants (For Non-Dermatologic Use)... 127 Enzyme Replacement/Modifiers... 127 Eye, Ear, Nose, Throat Agents... 129 Gastrointestinal Agents... 136 Genitourinary Agents... 148 Heavy Metal Antagonists... 149 Hormonal Agents, Stimulant/Replacement/Modifying... 150 Immunological Agents... 156 Inflammatory Bowel Disease Agents... 164 Irrigating Solutions... 165 Metabolic Bone Disease Agents... 165 Miscellaneous Therapeutic Agents... 166 Ophthalmic Agents... 172 Replacement Preparations... 173 Respiratory Tract Agents... 182 Skeletal Muscle Relaxants... 186 Sleep Disorder Agents... 187 Vasodilating Agents... 188 Vitamins And Minerals... 189 www.centersplan.com/fida/participants 2

Analgesics Analgesics, Miscellaneous acephen 120 mg suppository outer 120 mg * acephen 325 mg suppository outer 325 mg * acephen 650 mg suppository outer 650 mg * acetaminophen 120 mg suppos outer 120 mg * acetaminophen 160 mg/5 ml elx 160 mg/5 ml * acetaminophen 650 mg suppos 650 mg * acetaminophen 80 mg rapid tab children's 80 mg * acetaminophen 80 mg/0.8 ml drp infants 80 mg/0.8 ml * acetaminophen-codeine 120 mg-12 mg/5 ml solution 120-12 mg/5 ml acetaminophen-codeine oral solution 300 mg-30 mg /12.5 ml acetaminophen-codeine oral tablet 300-15 mg, 300-30 mg acetaminophen-codeine oral tablet 300-60 mg ALLZITAL ORAL TABLET 25-325 MG ascomp with codeine oral capsule 30-50-325-40 mg BELBUCA BUCCAL FILM 150 MCG, 300 MCG, 450 MCG, 600 MCG, 75 MCG, 750 MCG, 900 MCG buprenorphine hcl injection syringe 0.3 mg/ml butalbital compound w/codeine oral capsule 30-50-325-40 mg (Acetaminophen) (Acetaminophen) (Acetaminophen) (Acetaminophen) (Acetaminophen) (Acetaminophen) (Acetaminophen) (Acetaminophen) (Acetaminophen with Codeine) (Acetaminophen with Codeine) (Tylenol-Codeine No.3) (Tylenol-Codeine No.3) (Fiorinal with Codeine #3) (Buprenorphine HCl) (Fiorinal with Codeine #3) QL (360 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (240 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (2700 per 30 days) QL (2700 per 30 days) QL (360 per 30 days) QL (180 per 30 days) PA-HRM; QL (180 per 30 days) ST; QL (60 per 30 days) PA-HRM; QL (180 per 30 days) www.centersplan.com/fida/participants 3

butalbital-acetaminop-caf-cod oral capsule 50-300-40-30 mg, 50-325- 40-30 mg butalbital-acetaminophen oral tablet 50-325 mg butalbital-acetaminophen-caff oral capsule 50-325-40 mg butalbital-acetaminophen-caff oral tablet 50-325-40 mg butalbital-aspirin-caffeine oral capsule 50-325-40 mg BUTRANS TRANSDERMAL PATCH WEEKLY 10 MCG/HOUR, 15 MCG/HOUR, 20 MCG/HOUR, 5 MCG/HOUR, 7.5 MCG/HOUR (Fioricet with Codeine) (Tencon) (Esgic) (Esgic) (Fiorinal) capacet oral capsule 50-325-40 mg (Esgic) child non-aspirin 160 mg/5 ml children's 160 mg/5 ml * child pain & fever 160 mg/5 ml a/f,gluten/f,cherry 160 mg/5 ml * child tactinal 80 mg tab chw 80 mg * children's mapap 80 mg rapid 80 mg * children's silapap elixir 160 mg/5 ml * codeine sulfate oral tablet 15 mg, 30 mg, 60 mg cvs child non-asa 80 mg tb chw 80 mg * cvs non-aspirin jr tab chew 160 mg * cvs pain relief adult liquid 500 mg/15 ml * endocet oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg (Acetaminophen) (Infants' Tylenol) (Acetaminophen) (Acetaminophen) (Tylenol Sore Throat) (Codeine Sulfate) (Acetaminophen) (Acetaminophen) (Tylenol Sore Throat) (Xolox) PA-HRM; QL (180 per 30 days) PA-HRM; QL (180 per 30 days) PA-HRM; QL (180 per 30 days) PA-HRM; QL (180 per 30 days) PA-HRM; QL (180 per 30 days) QL (4 per 28 days) PA-HRM; QL (180 per 30 days) QL (240 per 30 days) QL (240 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (240 per 30 days) QL (180 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (120 per 30 days) QL (360 per 30 days) www.centersplan.com/fida/participants 4

endodan oral tablet 4.8355-325 mg (Percodan) QL (360 per 30 days) fentanyl citrate buccal lozenge on a handle 1,200 mcg, 1,600 mcg, 200 (Actiq) PA; QL (120 per 30 days) mcg, 400 mcg, 600 mcg, 800 mcg fentanyl transdermal patch 72 hour 100 mcg/hr, 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hour, 50 mcg/hr, 62.5 mcg/hour, 75 mcg/hr, 87.5 mcg/hour (Duragesic) QL (10 per 30 days) feverall 120 mg suppository QL (30 per 30 days) (Acetaminophen) children's, outer 120 mg * feverall 325 mg suppository junior QL (30 per 30 days) (Acetaminophen) str, outer 325 mg * feverall 650 mg suppository adult, QL (30 per 30 days) (Acetaminophen) outer 650 mg * hydrocodone-acetaminophen oral solution 10-325 mg/15 ml(15 ml), 2.5-167 mg/5 ml, 7.5-325 mg/15 ml hydrocodone-acetaminophen oral tablet 10-300 mg, 5-300 mg, 7.5-300 mg hydrocodone-acetaminophen oral tablet 10-325 mg, 2.5-325 mg, 5-325 mg, 7.5-325 mg hydrocodone-ibuprofen oral tablet 10-200 mg, 2.5-200 mg, 5-200 mg, 7.5-200 mg hydromorphone (pf) injection solution 10 mg/ml hydromorphone (pf) injection solution 4 mg/ml hydromorphone injection solution 2 mg/ml hydromorphone injection syringe 2 mg/ml (Hycet) (Norco) (Norco) (Ibudone) (Dilaudid-HP) (Dilaudid) QL (2700 per 30 days) (includes Vicodin, Vicodin ES and Vicodin HP); QL (390 per 30 days) QL (360 per 30 days) QL (150 per 30 days) (Hydromorphone HCl) (Hydromorphone HCl) hydromorphone oral liquid 1 mg/ml (Dilaudid) QL (1200 per 30 days) hydromorphone oral tablet 2 mg, 4 QL (180 per 30 days) (Dilaudid) mg www.centersplan.com/fida/participants 5

hydromorphone oral tablet 8 mg (Dilaudid) QL (240 per 30 days) HYSINGLA ER ORAL TABLET,ORAL ONLY,EXT.REL.24 HR 100 MG, 120 MG, 20 MG, 30 MG, 40 MG, 60 MG, 80 MG QL (30 per 30 days) junior mapap 160 mg rapid tab 160 QL (30 per 30 days) (Acetaminophen) mg * LAZANDA NASAL SPRAY,NON- AEROSOL 100 MCG/SPRAY, 400 MCG/SPRAY PA; QL (30 per 30 days) lorcet (hydrocodone) oral tablet 5- QL (360 per 30 days) (Norco) 325 mg lorcet hd oral tablet 10-325 mg (Norco) QL (360 per 30 days) lorcet plus oral tablet 7.5-325 mg (Norco) QL (360 per 30 days) mapap 160 mg/5 ml liquid 160 mg/5 QL (240 per 30 days) ml * mapap 160 mg/5 ml suspension 160 QL (240 per 30 days) (Infants' Tylenol) mg/5 ml * mapap 325 mg tablet 325 mg * (Tylenol) QL (360 per 30 days) mapap 500 mg capsule 500 mg * (Acetaminophen) QL (240 per 30 days) mapap 500 mg tablet 500 mg * (Tylenol) QL (240 per 30 days) mapap 500 mg/15 ml liquid 500 (Tylenol Sore QL (120 per 30 days) mg/15 ml * Throat) mapap 80 mg tablet chew 80 mg * (Acetaminophen) QL (30 per 30 days) mapap arthritis er 650 mg cplt 650 QL (180 per 30 days) (Acetaminophen) mg * margesic oral capsule 50-325-40 PA-HRM; QL (180 per (Esgic) mg 30 days) methadone injection solution 10 mg/ml (Methadone HCl) methadone oral solution 10 mg/5 QL (1800 per 30 days) (Methadone HCl) ml, 5 mg/5 ml methadone oral tablet 10 mg, 5 mg (Diskets) QL (360 per 30 days) methadose oral tablet,soluble 40 mg (Diskets) QL (90 per 30 days) morphine (pf) in 0.9 % nacl intravenous pt controlled analgesia syring 50 mg/25 ml (2 mg/ml) (Morphine Sulfate/0.9% Nacl/PF) www.centersplan.com/fida/participants 6

morphine 10 mg/ml carpuject 10 mg/ml (Morphine Sulfate) morphine 2 mg/ml carpuject 2 mg/ml (Morphine Sulfate) morphine 4 mg/ml carpuject 4 mg/ml (Morphine Sulfate) morphine 8 mg/ml syringe 8 mg/ml (Morphine Sulfate) morphine concentrate oral solution QL (200 per 30 days) (Morphine Sulfate) 100 mg/5 ml (20 mg/ml) morphine concentrate oral syringe 20 mg/ml (Morphine Sulfate) morphine in dextrose 5 % injection pt controlled analgesia syring 100 (Morphine mg/50 ml (2 mg/ml), 50 mg/25 ml (2 Sulfate/D5W) mg/ml) morphine injection solution 15 mg/ml, 8 mg/ml (Morphine Sulfate) morphine injection syringe 10 mg/ml (Morphine Sulfate) morphine intramuscular pen injector 10 mg/0.7 ml (Morphine Sulfate) morphine intravenous cartridge 15 mg/ml (Morphine Sulfate) morphine intravenous solution 25 mg/ml, 50 mg/ml (Morphine Sulfate) morphine intravenous syringe 10 mg/ml, 2 mg/ml, 4 mg/ml, 8 mg/ml (Morphine Sulfate) morphine oral solution 10 mg/5 ml (Morphine Sulfate) QL (700 per 30 days) morphine oral solution 20 mg/5 ml QL (300 per 30 days) (Morphine Sulfate) (4 mg/ml) MORPHINE ORAL TABLET 15 QL (180 per 30 days) MG, 30 MG morphine oral tablet extended QL (120 per 30 days) (MS Contin) release 100 mg, 30 mg, 60 mg morphine oral tablet extended QL (180 per 30 days) (MS Contin) release 15 mg, 200 mg morphine rectal suppository 10 mg, 20 mg, 30 mg, 5 mg (Morphine Sulfate) www.centersplan.com/fida/participants 7

non-aspirin x-str 167 mg/5 ml 500 (Tylenol Sore QL (120 per 30 days) mg/15 ml * Throat) nortemp 80 mg/0.8 ml drop 80 QL (30 per 30 days) (Acetaminophen) mg/0.8 ml * NUCYNTA ER ORAL TABLET QL (60 per 30 days) EXTENDED RELEASE 12 HR 100 MG, 150 MG, 200 MG, 250 MG, 50 MG NUCYNTA ORAL TABLET 100 QL (181 per 30 days) MG, 50 MG, 75 MG oxycodone oral concentrate 20 QL (180 per 30 days) (Oxycodone HCl) mg/ml oxycodone oral solution 5 mg/5 ml (Oxycodone HCl) QL (1300 per 30 days) oxycodone oral tablet 10 mg, 15 mg, QL (180 per 30 days) (Roxicodone) 20 mg, 30 mg, 5 mg oxycodone oral tablet,oral QL (60 per 30 days) only,ext.rel.12 hr 10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg (Oxycontin) oxycodone oral tablet,oral QL (120 per 30 days) (Oxycontin) only,ext.rel.12 hr 80 mg oxycodone-acetaminophen oral QL (360 per 30 days) tablet 10-325 mg, 2.5-325 mg, 5-325 (Xolox) mg, 7.5-325 mg oxycodone-acetaminophen oral QL (180 per 30 days) (Xolox) tablet 10-650 mg oxycodone-acetaminophen oral QL (240 per 30 days) (Xolox) tablet 7.5-500 mg oxycodone-aspirin oral tablet QL (360 per 30 days) (Percodan) 4.8355-325 mg OXYCONTIN ORAL QL (60 per 30 days) TABLET,ORAL ONLY,EXT.REL.12 HR 10 MG, 15 MG, 20 MG, 30 MG, 40 MG, 60 MG OXYCONTIN ORAL QL (120 per 30 days) TABLET,ORAL ONLY,EXT.REL.12 HR 80 MG www.centersplan.com/fida/participants 8

oxymorphone oral tablet 10 mg, 5 QL (180 per 30 days) (Opana) mg oxymorphone oral tablet extended QL (60 per 30 days) release 12 hr 10 mg, 15 mg, 20 mg, 5 mg, 7.5 mg (Opana ER) oxymorphone oral tablet extended QL (120 per 30 days) (Opana ER) release 12 hr 30 mg, 40 mg pain relief 500 mg capsule 500 mg * (Acetaminophen) QL (240 per 30 days) pain reliever er 650 mg caplet 8 QL (180 per 30 days) (Acetaminophen) hour, caplet 650 mg * pharbetol 325 mg tablet regular QL (360 per 30 days) (Tylenol) strength 325 mg * pharbetol 500 mg caplet extra-str, QL (240 per 30 days) (Tylenol) caplet 500 mg * pv non-aspirin 500 mg softgel exstr,liq filled 500 mg * QL (240 per 30 days) (Acetaminophen) q-pap 160 mg/5 ml solution a/f, (Tylenol Sore QL (240 per 30 days) cherry 160 mg/5 ml * Throat) q-pap 325 mg tablet 325 mg * (Tylenol) QL (360 per 30 days) q-pap 80 mg/0.8 ml drops 80 mg/0.8 QL (30 per 30 days) (Acetaminophen) ml * q-pap ex-str 500 mg tablet aspirin QL (240 per 30 days) (Tylenol) free 500 mg * ra jr acetaminophen 160 mg tab QL (30 per 30 days) (Acetaminophen) rapid melts 160 mg * reprexain oral tablet 10-200 mg, QL (150 per 30 days) (Ibudone) 2.5-200 mg, 5-200 mg (Oxycodone QL (1800 per 30 days) roxicet oral solution 5-325 mg/5 ml HCl/Acetaminophe n) silapap infant's drops infant's 80 QL (30 per 30 days) (Acetaminophen) mg/0.8 ml * sm arthritis pain er 650 mg caplet QL (180 per 30 days) (Acetaminophen) 650 mg * sm pain rel jr str tab chew 160 mg * (Acetaminophen) QL (30 per 30 days) sm pain reliever 80 mg tab QL (30 per 30 days) (Acetaminophen) children's 80 mg * tactinal 325 mg tablet 325 mg * (Tylenol) QL (360 per 30 days) www.centersplan.com/fida/participants 9

tactinal 500 mg tablet extra-strength 500 mg * (Tylenol) QL (240 per 30 days) tencon oral tablet 50-325 mg (Tencon) PA-HRM; QL (180 per 30 days) tramadol oral tablet 50 mg (Ultram) QL (240 per 30 days) tramadol-acetaminophen oral tablet 37.5-325 mg (Ultracet) QL (240 per 30 days) vicodin es oral tablet 7.5-300 mg (Norco) (includes Vicodin, Vicodin ES and Vicodin HP); QL (390 per 30 days) vicodin hp oral tablet 10-300 mg (Norco) (includes Vicodin, Vicodin ES and Vicodin HP); QL (390 per 30 days) vicodin oral tablet 5-300 mg (Norco) (includes Vicodin, Vicodin ES and Vicodin HP); QL (390 per 30 days) xylon 10 oral tablet 10-200 mg (Ibudone) QL (150 per 30 days) zebutal oral capsule 50-325-40 mg (Esgic) Nonsteroidal Anti- Inflammatory Agents ADVIL 100 MG TABLET JR STRENGTH,COATED 100 MG * ADVIL 200 MG TABLET 200 MG * ADVIL JR STR 100 MG TAB CHEW TB CHEW,8 HOUR,GRAPE 100 MG * aspirin 300 mg suppository 300 mg * (Aspirin) aspirin 325 mg tablet 325 mg * (Ecotrin) aspirin 600 mg suppository 600 mg (Aspirin) * aspirin 81 mg chewable tablet 81 mg * (Bayer Chewable Aspirin) PA-HRM; QL (180 per 30 days) www.centersplan.com/fida/participants 10

aspirin buffered 325 mg tab 325 mg (Aspirin/Calcium * Carbonate/Mag) aspirin ec 325 mg tablet 325 mg * (Ecotrin) aspirin ec 500 mg tablet 500 mg * (Ecotrin) aspirin ec 81 mg tablet low dose 81 (Ecotrin) mg * aspir-low ec 81 mg tablet 81 mg * (Ecotrin) CALDOLOR INTRAVENOUS RECON SOLN 400 MG/4 ML (100 MG/ML) celecoxib oral capsule 100 mg, 200 (Celebrex) mg, 400 mg, 50 mg CHILDREN'S ADVIL 100 MG/5 ML A/F (OTC) 100 MG/5 ML * cvs ibuprofen 200 mg softgel liquid (Advil) filled,softge 200 mg * diclofenac sodium oral tablet (Voltaren-XR) extended release 24 hr 100 mg diclofenac sodium oral (Diclofenac tablet,delayed release (dr/ec) 25 mg, Sodium) 50 mg, 75 mg diclofenac sodium topical gel 3 % (Voltaren) diclofenac-misoprostol oral tablet,ir,delayed rel,biphasic 50-200 (Arthrotec 50) mg-mcg, 75-200 mg-mcg diflunisal oral tablet 500 mg (Diflunisal) ecpirin ec 325 mg tablet 325 mg * (Ecotrin) etodolac oral capsule 200 mg, 300 (Etodolac) mg etodolac oral tablet 400 mg, 500 mg (Etodolac) bufferin 325 mg tablet coated 325 choline,magnesium salicylate oral diclofenac potassium oral tablet 50 (Aspirin/Calcium (Choline Sal/Mag (Diclofenac mg * liquid 500 mg/5 ml mg Carbonate/Mag) Salicylate) Potassium) QL (60 per 30 days) www.centersplan.com/fida/participants 11

etodolac oral tablet extended release 24 hr 400 mg, 500 mg, 600 mg fenoprofen oral tablet 600 mg (Etodolac) (Fenoprofen Calcium) FLECTOR TRANSDERMAL PATCH 12 HOUR 1.3 % flurbiprofen oral tablet 100 mg, 50 mg (Flurbiprofen) gnp ibuprofen jr str 100 mg tb 100 mg * (Advil) ibuprofen 100 mg/5 ml susp children's (otc) 100 mg/5 ml * (Children'S Advil) ibuprofen 200 mg tablet 200 mg * (Advil) ibuprofen oral suspension 100 mg/5 ml (Ibuprofen) ibuprofen oral tablet 400 mg, 600 mg, 800 mg (Ibuprofen) indomethacin oral capsule 25 mg (Indomethacin) indomethacin oral capsule 50 mg (Indomethacin) indomethacin oral capsule, extended (Indomethacin) release 75 mg indomethacin sodium intravenous (Indomethacin recon soln 1 mg Sodium) infant ibuprofen 50 mg/1.25 ml d/f,a/f,non-staining 50 mg/1.25 ml * (Infants' Motrin) INFANTS' MOTRIN 50 MG/1.25 ML D/F, BERRY FLAVOR 50 3 $0 MG/1.25 ML * ketoprofen oral capsule 50 mg, 75 mg (Ketoprofen) ketoprofen oral capsule,ext rel. pellets 24 hr 200 mg (Ketoprofen) ketorolac oral tablet 10 mg (Ketorolac Tromethamine) mefenamic acid oral capsule 250 mg (Ponstel) PA PA-HRM; QL (240 per 30 days) PA-HRM; QL (120 per 30 days) PA-HRM; QL (60 per 30 days) PA-HRM QL (20 per 30 days) www.centersplan.com/fida/participants 12

meloxicam oral suspension 7.5 mg/5 ml (Mobic) meloxicam oral tablet 15 mg, 7.5 mg (Mobic) nabumetone oral tablet 500 mg, 750 mg (Nabumetone) naproxen oral suspension 125 mg/5 ml (Naprosyn) naproxen oral tablet 250 mg, 375 mg, 500 mg (Naprosyn) naproxen oral tablet,delayed release (Ec-Naprosyn) (dr/ec) 375 mg, 500 mg naproxen sodium oral tablet 275 mg, 550 mg (Anaprox) piroxicam oral capsule 10 mg, 20 mg (Feldene) ra aspirin tri-buffered tb 325 mg * (Aspirin/Calcium Carbonate/Mag) sm ibuprofen ib 100 mg tablet junior (Advil) strength 100 mg * st. joseph aspirin 81 mg chew (Bayer Chewable orange 81 mg * Aspirin) st. joseph aspirin ec 81 mg tb enteric coated 81 mg * (Ecotrin) sulindac oral tablet 150 mg, 200 mg (Sulindac) tolmetin oral capsule 400 mg (Tolmetin Sodium) tolmetin oral tablet 200 mg, 600 mg (Tolmetin Sodium) VOLTAREN TOPICAL GEL 1 % wal-profen 200 mg softgel softgel 200 mg * (Advil) Anesthetics Local Anesthetics glydo mucous membrane jelly in applicator 2 % (Lidocaine HCl) lidocaine (pf) injection solution 15 mg/ml (1.5 %), 40 mg/ml (4 %), 5 (Xylocaine-MPF) mg/ml (0.5 %) lidocaine 2% viscous soln 2 % (Xylocaine) www.centersplan.com/fida/participants 13

lidocaine hcl injection solution 10 mg/ml (1 %), 20 mg/ml (2 %) (Xylocaine) lidocaine hcl laryngotracheal solution 4 % (Xylocaine) lidocaine hcl mucous membrane gel 2 % (Lidocaine HCl) lidocaine hcl mucous membrane jelly in applicator 2 % (Lidocaine HCl) lidocaine hcl mucous membrane solution 2 %, 4 % (40 mg/ml) (Xylocaine) lidocaine hcl urethral gel 2 % (Lidocaine HCl) lidocaine topical adhesive patch,medicated 5 % (Lidoderm) lidocaine topical ointment 5 % (Lidocaine) lidocaine-prilocaine topical cream 2.5-2.5 % (EMLA) Anti-Addiction/Substance Abuse Treatment Agents Anti-Addiction/Substance Abuse Treatment Agents acamprosate oral tablet,delayed release (dr/ec) 333 mg buprenorphine hcl sublingual tablet 2 mg, 8 mg buprenorphine-naloxone sublingual tablet 2-0.5 mg, 8-2 mg bupropion hcl sr 150 mg tablet f/c 150 mg CHANTIX CONTINUING MONTH BOX ORAL TABLET 1 MG CHANTIX ORAL TABLET 0.5 MG, 1 MG CHANTIX STARTING MONTH BOX ORAL TABLETS,DOSE PACK 0.5 MG (11)- 1 MG (42) (Acamprosate Calcium) (Buprenorphine HCl) (Buprenorphine HCl/Naloxone HCl) (Zyban) PA PA; QL (90 per 30 days) PA; QL (90 per 30 days) QL (168 per 84 days) QL (168 per 84 days) QL (53 per 28 days) www.centersplan.com/fida/participants 14

disulfiram oral tablet 250 mg, 500 mg (Antabuse) naloxone injection solution 0.4 mg/ml (Naloxone HCl) naloxone injection syringe 0.4 mg/ml, 1 mg/ml (Naloxone HCl) naltrexone oral tablet 50 mg (Revia) NARCAN NASAL SPRAY,NON- AEROSOL 4 MG/ACTUATION NICODERM CQ 14 MG/24HR PATCH 14 MG/24 HR * NICODERM CQ 21 MG/24HR PATCH 21 MG/24 HR * NICODERM CQ 7 MG/24HR PATCH 7 MG/24 HR * nicorelief 2 mg gum 2 mg * (Nicorette) nicorelief 4 mg gum 4 mg * (Nicorette) nicorette 2 mg chewing gum white ice mint 2 mg * (Nicorette) nicotine 14 mg/24hr patch outer (otc) 14 mg/24 hr * (Nicoderm Cq) nicotine 2 mg chewing gum sugar free 2 mg * (Nicorette) nicotine 2 mg lozenge mint, 3 quittube 2 mg * (Nicorette) nicotine 21 mg/24hr patch step 1 (otc) 21 mg/24 hr * (Nicoderm Cq) nicotine 22 mg/24hr patch 1 week starter kit 22 mg/24 hr * (Nicoderm Cq) nicotine 4 mg chewing gum 4 mg * (Nicorette) nicotine 4 mg lozenge mint, 3 quittube 4 mg * (Nicorette) nicotine 7 mg/24hr patch (otc) 7 mg/24 hr * (Nicoderm Cq) NICOTROL INHALATION CARTRIDGE 10 MG QL (4 per 30 days) QL (168 per 365 days) QL (168 per 365 days) QL (180 per 365 days) QL (168 per 365 days) QL (168 per 365 days) QL (180 per 365 days) QL (1008 per 90 days) www.centersplan.com/fida/participants 15

ZUBSOLV SUBLINGUAL TABLET 1.4-0.36 MG, 11.4-2.9 MG, 2.9-0.71 MG, 5.7-1.4 MG, 8.6-2.1 MG Antianxiety Agents Benzodiazepines alprazolam oral tablet 0.25 mg, 0.5 PA; QL (90 per 30 days) QL (120 per 30 days) (Xanax) mg, 1 mg, 2 mg chlordiazepoxide hcl oral capsule (Chlordiazepoxide QL (120 per 30 days) 10 mg, 25 mg, 5 mg HCl) clonazepam oral tablet 0.5 mg, 1 mg (Klonopin) QL (90 per 30 days) clonazepam oral tablet 2 mg (Klonopin) QL (300 per 30 days) clonazepam oral tablet,disintegrating 0.125 mg, 0.25 mg, 0.5 mg, 1 mg (Clonazepam) QL (90 per 30 days) clonazepam oral QL (300 per 30 days) (Clonazepam) tablet,disintegrating 2 mg clorazepate dipotassium oral tablet QL (120 per 30 days) (Tranxene T-Tab) 15 mg clorazepate dipotassium oral tablet QL (60 per 30 days) (Tranxene T-Tab) 3.75 mg, 7.5 mg diazepam injection syringe 5 mg/ml (Diazepam) QL (10 per 28 days) diazepam intensol oral concentrate QL (1200 per 30 days) (Diazepam) 5 mg/ml diazepam oral solution 5 mg/5 ml (1 QL (1200 per 30 days) (Diazepam) mg/ml) diazepam oral tablet 10 mg, 2 mg, 5 QL (120 per 30 days) (Valium) mg diazepam rectal kit 12.5-15-17.5-20 mg, 2.5 mg, 5-7.5-10 mg (Diastat) lorazepam oral tablet 0.5 mg, 1 mg, QL (90 per 30 days) (Ativan) 2 mg ONFI ORAL SUSPENSION 2.5 PA NSO; QL (480 per MG/ML 30 days) Antibacterials Aminoglycosides www.centersplan.com/fida/participants 16

BETHKIS INHALATION SOLUTION FOR NEBULIZATION 300 MG/4 ML gentamicin in nacl (iso-osm) intravenous piggyback 100 mg/100 ml, 100 mg/50 ml, 60 mg/50 ml, 70 mg/50 ml, 80 mg/100 ml, 80 mg/50 ml, 90 mg/100 ml gentamicin injection solution 40 mg/ml gentamicin ped 20 mg/2 ml vial 25's,pedi,latex-free 20 mg/2 ml gentamicin sulfate (pf) intravenous solution 80 mg/8 ml (Gentamicin In Nacl, Iso-Osm) (Gentamicin Sulfate) (Gentamicin Sulfate/PF) (Gentamicin Sulfate/PF) neomycin oral tablet 500 mg (Neomycin Sulfate) streptomycin intramuscular recon (Streptomycin soln 1 gram Sulfate) TOBI PODHALER INHALATION CAPSULE, W/INHALATION DEVICE 28 MG tobramycin in 0.225 % nacl inhalation solution for nebulization 300 mg/5 ml tobramycin in 0.9 % nacl intravenous piggyback 60 mg/50 ml, 80 mg/100 ml tobramycin sulfate injection solution 10 mg/ml, 40 mg/ml Antibacterials, Miscellaneous bacitracin intramuscular recon soln 50,000 unit chloramphenicol sod succinate intravenous recon soln 1 gram clindamycin 75 mg/5 ml soln 75 mg/5 ml clindamycin hcl oral capsule 150 mg, 300 mg, 75 mg (Tobi) (Tobramycin/Sodiu m Chloride) (Tobramycin Sulfate) (Bacitracin) (Chloramphenicol Sod Succ) (Cleocin Palmitate) (Cleocin HCl) QL (224 per 28 days) www.centersplan.com/fida/participants 17

clindamycin in 5 % dextrose intravenous piggyback 300 mg/50 ml, 600 mg/50 ml, 900 mg/50 ml clindamycin pediatric oral recon soln 75 mg/5 ml clindamycin phosphate injection solution 150 mg/ml clindamycin phosphate intravenous solution 600 mg/4 ml colistin (colistimethate na) injection recon soln 150 mg CUBICIN INTRAVENOUS RECON SOLN 500 MG linezolid intravenous parenteral solution 600 mg/300 ml linezolid oral suspension for reconstitution 100 mg/5 ml (Cleocin Phosphate In D5w) (Cleocin Palmitate) (Cleocin Phosphate) (Cleocin Phosphate) (Coly-Mycin M Parenteral) (Zyvox) (Zyvox) linezolid oral tablet 600 mg (Zyvox) methenamine hippurate oral tablet 1 gram (Hiprex) metronidazole in nacl (iso-os) (Metronidazole/So intravenous piggyback 500 mg/100 dium Chloride) ml metronidazole oral capsule 375 mg (Flagyl) metronidazole oral tablet 250 mg, 500 mg (Flagyl) nitrofurantoin macrocrystal oral capsule 100 mg, 25 mg (Macrodantin) nitrofurantoin macrocrystal oral capsule 50 mg (Macrodantin) PA-HRM; QL (120 per 30 days) PA-HRM; (High Risk Med. QL applies to all participants; PA required for 65 years and older with over 90 days cumulative use of nitrofurantoin drugs); QL (120 per 30 days) www.centersplan.com/fida/participants 18

nitrofurantoin monohyd/m-cryst oral capsule 100 mg nitrofurantoin monohyd/m-cryst oral capsule 100 mg (75/25) (Macrobid) (Macrobid) polymyxin b sulfate injection recon (Polymyxin B soln 500,000 unit Sulfate) SYNERCID INTRAVENOUS RECON SOLN 500 MG trimethoprim oral tablet 100 mg (Trimethoprim) vancomycin hcl 1g/200 ml bag 1 (Vancomycin gram/200 ml HCl/D5W) vancomycin intravenous recon soln 1,000 mg, 10 gram, 750 mg (Vancomycin HCl) vancomycin intravenous recon soln (Vancomycin 500 mg HCl/D5W) vancomycin oral capsule 125 mg, 250 mg (Vancocin HCl) XIFAXAN ORAL TABLET 200 MG XIFAXAN ORAL TABLET 550 MG ZYVOX ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML Cephalosporins cefaclor oral capsule 250 mg, 500 mg (Cefaclor) PA-HRM; (High Risk Med. QL applies to all participants; PA required for 65 years and older with over 90 days cumulative use of nitrofurantoin drugs); QL (120 per 30 days) PA-HRM; (High Risk Med. QL applies to all participants; PA required for 65 years and older with over 90 days cumulative use of nitrofurantoin drugs); QL (120 per 30 days) PA; QL (9 per 30 days) PA www.centersplan.com/fida/participants 19

cefaclor oral suspension for reconstitution 125 mg/5 ml, 250 (Cefaclor) mg/5 ml, 375 mg/5 ml cefadroxil oral capsule 500 mg (Cefadroxil) cefadroxil oral suspension for reconstitution 250 mg/5 ml, 500 (Cefadroxil) mg/5 ml cefadroxil oral tablet 1 gram (Cefadroxil) CEFAZOLIN IN DEXTROSE (ISO-OS) INTRAVENOUS PIGGYBACK 1 GRAM/50 ML cefazolin in dextrose (iso-os) intravenous piggyback 2 gram/50 ml (Cefazolin Sodium/Dextrose, Iso) cefazolin injection recon soln 1 gram, 10 gram, 500 mg (Cefazolin Sodium) cefdinir oral capsule 300 mg (Cefdinir) cefdinir oral suspension for reconstitution 125 mg/5 ml, 250 (Cefdinir) mg/5 ml cefditoren pivoxil oral tablet 200 mg, 400 mg (Spectracef) CEFEPIME 2 GM INJECTION 2 GRAM/100 ML CEFEPIME IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK 1 GRAM/50 ML, 2 GRAM/50 ML cefepime injection recon soln 1 gram, 2 gram (Maxipime) cefotaxime injection recon soln 1 gram, 10 gram, 2 gram, 500 mg (Claforan) (Cefoxitin cefoxitin in dextrose, iso-osm Sodium/Dextrose, intravenous piggyback 2 gram/50 ml Iso) cefoxitin intravenous recon soln 1 gram, 10 gram, 2 gram (Cefoxitin Sodium) www.centersplan.com/fida/participants 20

cefpodoxime oral suspension for reconstitution 100 mg/5 ml, 50 mg/5 ml cefpodoxime oral tablet 100 mg, 200 mg cefprozil oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml (Cefpodoxime Proxetil) (Cefpodoxime Proxetil) (Cefprozil) cefprozil oral tablet 250 mg, 500 mg (Cefprozil) ceftazidime injection recon soln 2 gram, 6 gram (Fortaz) ceftibuten oral capsule 400 mg (Cedax) ceftibuten oral suspension for reconstitution 180 mg/5 ml (Cedax) ceftriaxone 1 gm piggyback 50ml (Ceftriaxone galaxycontainer 1 gram/50 ml Na/Dextrose, Iso) ceftriaxone 1 gm vial 10's, fliptop,l/f 1 gram (Rocephin) ceftriaxone 2 gm piggyback 50ml (Ceftriaxone galaxycontainer 2 gram/50 ml Na/Dextrose, Iso) ceftriaxone injection recon soln 10 gram, 250 mg, 500 mg (Rocephin) ceftriaxone intravenous recon soln 1 (Ceftriaxone gram, 2 gram Na/Dextrose, Iso) cefuroxime axetil oral tablet 250 mg, 500 mg (Ceftin) cefuroxime sodium injection recon soln 1.5 gram, 750 mg (Zinacef) cefuroxime sodium intravenous recon soln 7.5 gram (Zinacef) cephalexin oral capsule 250 mg, 500 mg, 750 mg (Keflex) cephalexin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml (Cephalexin) cephalexin oral tablet 250 mg, 500 mg (Cephalexin) www.centersplan.com/fida/participants 21

MEFOXIN IN DEXTROSE (ISO- OSM) INTRAVENOUS PIGGYBACK 1 GRAM/50 ML, 2 GRAM/50 ML SUPRAX ORAL TABLET,CHEWABLE 100 MG, 200 MG tazicef injection recon soln 2 gram, 6 gram (Fortaz) TEFLARO INTRAVENOUS RECON SOLN 400 MG, 600 MG Macrolides azithromycin intravenous recon soln 500 mg (Zithromax) azithromycin oral packet 1 gram (Zithromax) azithromycin oral suspension for reconstitution 100 mg/5 ml, 200 (Zithromax) mg/5 ml azithromycin oral tablet 250 mg, 250 mg (6 pack), 600 mg (Zithromax) azithromycin oral tablet 500 mg (Zithromax) clarithromycin oral suspension for reconstitution 125 mg/5 ml, 250 (Biaxin) mg/5 ml clarithromycin oral tablet 250 mg, 500 mg (Biaxin) clarithromycin oral tablet extended release 24 hr 500 mg (Clarithromycin) DIFICID ORAL TABLET 200 MG QL (20 per 10 days) e.e.s. 400 oral tablet 400 mg (Erythromycin Ethylsuccinate) e.e.s. granules oral suspension for reconstitution 200 mg/5 ml (Eryped 200) ery-tab oral tablet,delayed release (Erythromycin (dr/ec) 250 mg, 500 mg Base) ERY-TAB ORAL TABLET,DELAYED RELEASE (DR/EC) 333 MG www.centersplan.com/fida/participants 22

erythrocin (as stearate) oral tablet 250 mg ERYTHROCIN INTRAVENOUS RECON SOLN 1,000 MG, 500 MG erythromycin ethylsuccinate oral tablet 400 mg erythromycin oral capsule,delayed release(dr/ec) 250 mg erythromycin oral tablet 250 mg, 500 mg Miscellaneous B-Lactam Antibiotics aztreonam injection recon soln 1 gram CAYSTON INHALATION SOLUTION FOR NEBULIZATION 75 MG/ML imipenem-cilastatin intravenous recon soln 250 mg, 500 mg INVANZ INJECTION RECON SOLN 1 GRAM meropenem intravenous recon soln 500 mg meropenem iv 1 gm vial outer, latexfree 1 gram Penicillins amoxicillin oral capsule 250 mg, 500 mg amoxicillin oral suspension for reconstitution 125 mg/5 ml, 200 mg/5 ml, 250 mg/5 ml, 400 mg/5 ml amoxicillin oral tablet 500 mg, 875 mg amoxicillin oral tablet,chewable 125 mg, 250 mg (Erythromycin Stearate) (Erythromycin Ethylsuccinate) (Erythromycin Base) (Erythromycin Base) (Azactam) (Primaxin) (Merrem) (Merrem) (Amoxicillin) (Amoxicillin) (Amoxicillin) (Amoxicillin) LA www.centersplan.com/fida/participants 23

amoxicillin-pot clavulanate oral suspension for reconstitution 200-28.5 mg/5 ml, 250-62.5 mg/5 ml, 400-57 mg/5 ml, 600-42.9 mg/5 ml amoxicillin-pot clavulanate oral tablet 250-125 mg, 500-125 mg, 875-125 mg amoxicillin-pot clavulanate oral tablet extended release 12 hr 1,000-62.5 mg amoxicillin-pot clavulanate oral tablet,chewable 200-28.5 mg, 400-57 mg ampicillin 2 gm vial 10's, latex-free 2 gram ampicillin oral capsule 250 mg, 500 mg ampicillin oral suspension for reconstitution 125 mg/5 ml, 250 mg/5 ml ampicillin sodium injection recon soln 1 gram, 10 gram, 125 mg ampicillin sodium intravenous recon soln 2 gram ampicillin-sulbactam 1.5 gm vl p/f, latex-free 1.5 gram ampicillin-sulbactam injection recon soln 15 gram, 3 gram ampicillin-sulbactam intravenous recon soln 1.5 gram BICILLIN C-R INTRAMUSCULAR SYRINGE 1,200,000 UNIT/ 2 ML(600K/600K), 1,200,000 UNIT/ 2 ML(900K/300K) BICILLIN L-A INTRAMUSCULAR SYRINGE 1,200,000 UNIT/2 ML, 2,400,000 UNIT/4 ML, 600,000 UNIT/ML (Augmentin) (Augmentin) (Augmentin XR) (Amoxicillin/Potas sium Clav) (Ampicillin Sodium) (Ampicillin Trihydrate) (Ampicillin Trihydrate) (Ampicillin Sodium) (Ampicillin Sodium) (Unasyn) (Unasyn) (Unasyn) www.centersplan.com/fida/participants 24

dicloxacillin oral capsule 250 mg, 500 mg nafcillin 2 gm vial sterile, latex-free 2 gram nafcillin injection recon soln 1 gram, 10 gram nafcillin intravenous recon soln 2 gram oxacillin 1 gm add-vantage vl addvantage, inner 1 gram oxacillin in dextrose(iso-osm) intravenous piggyback 1 gram/50 ml, 2 gram/50 ml oxacillin injection recon soln 10 gram oxacillin intravenous recon soln 2 gram penicillin g pot in dextrose intravenous piggyback 1 million unit/50 ml, 2 million unit/50 ml, 3 million unit/50 ml penicillin g potassium injection recon soln 5 million unit penicillin g procaine intramuscular syringe 1.2 million unit/2 ml, 600,000 unit/ml penicillin gk 20 million unit 20 million unit penicillin v potassium oral recon soln 125 mg/5 ml, 250 mg/5 ml penicillin v potassium oral tablet 250 mg, 500 mg pfizerpen-g injection recon soln 20 million unit piperacillin-tazobactam intravenous recon soln 2.25 gram, 3.375 gram, 4.5 gram (Dicloxacillin Sodium) (Nafcillin Sodium) (Nafcillin Sodium) (Nafcillin Sodium) (Oxacillin Sodium) (Oxacillin Sodium/Dextrose, Iso) (Oxacillin Sodium) (Oxacillin Sodium) (Pen G Pot/Dextrose- Water) (Penicillin G Potassium) (Penicillin G Procaine) (Penicillin G Potassium) (Penicillin V Potassium) (Penicillin V Potassium) (Penicillin G Potassium) (Zosyn) www.centersplan.com/fida/participants 25

piperacil-tazobact 40.5 gram p/f, pharmacy bulk 40.5 gram (Zosyn) Quinolones ciprofloxacin 200 mg/20 ml vl (Ciprofloxacin sdv,latex-free 200 mg/20 ml Lactate) ciprofloxacin hcl oral tablet 100 mg, (Cipro) 250 mg, 500 mg, 750 mg ciprofloxacin in 5 % dextrose intravenous piggyback 200 mg/100 ml (Cipro I.V.) ciprofloxacin lactate intravenous (Ciprofloxacin solution 400 mg/40 ml Lactate) ciprofloxacin oral suspension,microcapsule recon 250 (Cipro) mg/5 ml, 500 mg/5 ml ciprofloxacn-d5w 400 mg/200 ml p/f,latex/f, in d5w 400 mg/200 ml (Cipro I.V.) levofloxacin in d5w intravenous piggyback 500 mg/100 ml, 750 (Levaquin) mg/150 ml levofloxacin intravenous solution 25 mg/ml (Levofloxacin) levofloxacin oral solution 250 mg/10 ml (Levaquin) levofloxacin oral tablet 250 mg, 500 mg, 750 mg (Levaquin) moxifloxacin oral tablet 400 mg (Avelox) ofloxacin oral tablet 400 mg (Ofloxacin) Sulfonamides sulfadiazine oral tablet 500 mg (Sulfadiazine) sulfamethoxazole-trimethoprim intravenous solution 400-80 mg/5 ml sulfamethoxazole-trimethoprim oral suspension 200-40 mg/5 ml sulfamethoxazole-trimethoprim oral tablet 400-80 mg, 800-160 mg (Sulfamethoxazole/ Trimethoprim) (Sulfamethoxazole/ Trimethoprim) (Bactrim) sulfasalazine oral tablet 500 mg (Azulfidine) www.centersplan.com/fida/participants 26

sulfasalazine oral tablet,delayed release (dr/ec) 500 mg sulfatrim oral suspension 200-40 mg/5 ml Tetracyclines doxy 100 vial 10's, p/f 100 mg doxycycline hyclate 100 mg cap 100 mg doxycycline hyclate 100 mg tab f/c 100 mg doxycycline hyclate intravenous recon soln 100 mg doxycycline hyclate oral capsule 100 mg doxycycline hyclate oral capsule 50 mg doxycycline hyclate oral tablet 100 mg, 50 mg doxycycline hyclate oral tablet 20 mg doxycycline mono 100 mg cap 100 mg doxycycline mono 100 mg tablet f/c 100 mg doxycycline mono 50 mg tablet 50 mg doxycycline monohydrate oral capsule 150 mg, 50 mg, 75 mg doxycycline monohydrate oral suspension for reconstitution 25 mg/5 ml doxycycline monohydrate oral tablet 150 mg, 75 mg minocycline oral capsule 100 mg, 50 mg, 75 mg minocycline oral tablet 100 mg, 50 mg, 75 mg (Azulfidine) (Sulfamethoxazole/ Trimethoprim) (Doxycycline Hyclate) (Morgidox) (Doryx) (Doxycycline Hyclate) (Adoxa) (Morgidox) (Avidoxy) (Doryx) (Adoxa) (Avidoxy) (Avidoxy) (Adoxa) (Vibramycin) (Avidoxy) (Minocin) (Minocycline HCl) www.centersplan.com/fida/participants 27

tetracycline oral capsule 250 mg, 500 mg TYGACIL INTRAVENOUS RECON SOLN 50 MG Anticancer Agents Anticancer Agents ABRAXANE INTRAVENOUS SUSPENSION FOR RECONSTITUTION 100 MG ADCETRIS INTRAVENOUS RECON SOLN 50 MG adriamycin intravenous recon soln 10 mg, 20 mg, 50 mg adriamycin intravenous solution 10 mg/5 ml adrucil 2,500 mg/50 ml vial outer, latex-free 2.5 gram/50 ml adrucil intravenous solution 500 mg/10 ml AFINITOR DISPERZ ORAL TABLET FOR SUSPENSION 2 MG, 3 MG, 5 MG (Tetracycline HCl) (Doxorubicin HCl) (Doxorubicin HCl) (Fluorouracil) (Fluorouracil) AFINITOR ORAL TABLET 10 MG AFINITOR ORAL TABLET 2.5 MG, 5 MG, 7.5 MG ALECENSA ORAL CAPSULE 150 MG ALIMTA INTRAVENOUS RECON SOLN 500 MG anastrozole oral tablet 1 mg (Arimidex) AVASTIN INTRAVENOUS SOLUTION 25 MG/ML, 25 MG/ML (16 ML) azacitidine injection recon soln 100 mg BELEODAQ INTRAVENOUS RECON SOLN 500 MG (Vidaza) PA NSO; QL (4 per 21 days) PA NSO; QL (112 per 28 days) PA NSO; QL (56 per 28 days) PA NSO; QL (28 per 28 days) PA NSO; QL (240 per 30 days) PA NSO PA NSO www.centersplan.com/fida/participants 28

BENDEKA INTRAVENOUS SOLUTION 25 MG/ML bexarotene oral capsule 75 mg (Targretin) bicalutamide oral tablet 50 mg (Casodex) bleomycin injection recon soln 30 (Bleomycin unit Sulfate) bleomycin sulfate 15 unit vial latexfree 15 unit Sulfate) (Bleomycin BLINCYTO INTRAVENOUS KIT 35 MCG BOSULIF ORAL TABLET 100 MG BOSULIF ORAL TABLET 500 MG CABOMETYX ORAL TABLET 20 MG, 60 MG CABOMETYX ORAL TABLET 40 MG CAPRELSA ORAL TABLET 100 MG CAPRELSA ORAL TABLET 300 MG COMETRIQ ORAL CAPSULE 100 MG/DAY(80 MG[1]-20 MG[1]), 140 MG/DAY(80 MG[1]-20 MG[3]), 60 MG/DAY (20 MG [3]/DAY) COTELLIC ORAL TABLET 20 MG cyclophosphamide intravenous (Cyclophosphamid recon soln 1 gram, 2 gram, 500 mg e) CYCLOPHOSPHAMIDE ORAL CAPSULE 25 MG, 50 MG cyclophosphamide oral tablet 25 (Cyclophosphamid mg, 50 mg e) PA NSO PA NSO; QL (420 per 30 days) PA NSO; QL (140 per 365 days) PA NSO; QL (120 per 30 days) PA NSO; QL (30 per 30 days) PA NSO; QL (30 per 30 days) PA NSO; QL (60 per 30 days) PA NSO; QL (60 per 30 days) PA NSO; QL (30 per 30 days) PA NSO; QL (112 per 28 days) PA NSO; LA; QL (63 per 28 days) ; ST ; ST www.centersplan.com/fida/participants 29

CYRAMZA INTRAVENOUS SOLUTION 10 MG/ML, 10 MG/ML (50 ML) dactinomycin intravenous recon soln 0.5 mg (Dactinomycin) DARZALEX INTRAVENOUS SOLUTION 20 MG/ML decitabine intravenous recon soln 50 mg (Dacogen) doxorubicin, peg-liposomal intravenous suspension 2 mg/ml (Doxil) DROXIA ORAL CAPSULE 200 MG, 300 MG, 400 MG ELIGARD SUBCUTANEOUS SYRINGE 22.5 MG (3 MONTH) ELIGARD SUBCUTANEOUS SYRINGE 30 MG (4 MONTH) ELIGARD SUBCUTANEOUS SYRINGE 45 MG (6 MONTH) ELIGARD SUBCUTANEOUS SYRINGE 7.5 MG (1 MONTH) EMCYT ORAL CAPSULE 140 MG EMPLICITI INTRAVENOUS RECON SOLN 300 MG, 400 MG ERIVEDGE ORAL CAPSULE 150 MG ETOPOPHOS INTRAVENOUS RECON SOLN 100 MG etoposide intravenous solution 20 mg/ml (Etoposide) exemestane oral tablet 25 mg (Aromasin) FARESTON ORAL TABLET 60 MG FARYDAK ORAL CAPSULE 10 MG, 15 MG, 20 MG FASLODEX INTRAMUSCULAR SYRINGE 250 MG/5 ML PA NSO PA NSO; LA QL (1 per 84 days) QL (1 per 112 days) QL (1 per 168 days) PA NSO PA NSO; QL (30 per 30 days) PA NSO www.centersplan.com/fida/participants 30

floxuridine injection recon soln 0.5 gram (Floxuridine) fluorouracil 5,000 mg/100 ml latexfree 5 gram/100 ml (Fluorouracil) fluorouracil intravenous solution 2.5 gram/50 ml (Fluorouracil) flutamide oral capsule 125 mg (Flutamide) GAZYVA INTRAVENOUS SOLUTION 1,000 MG/40 ML GILOTRIF ORAL TABLET 20 MG, 30 MG, 40 MG GLEEVEC ORAL TABLET 100 MG GLEEVEC ORAL TABLET 400 MG GLEOSTINE ORAL CAPSULE 10 MG, 100 MG, 40 MG HERCEPTIN INTRAVENOUS RECON SOLN 440 MG HEXALEN ORAL CAPSULE 50 MG hydroxyurea oral capsule 500 mg (Hydrea) IBRANCE ORAL CAPSULE 100 MG, 125 MG, 75 MG ICLUSIG ORAL TABLET 15 MG ICLUSIG ORAL TABLET 45 MG ifosfamide 1 gm/20 ml vial sd polymer vial 1 gram/20 ml ifosfamide intravenous recon soln 1 gram ifosfamide-mesna intravenous kit 1-1 gram, 3,000-1,000 mg IMBRUVICA ORAL CAPSULE 140 MG (Ifex) (Ifex) (Ifosfamide/Mesna ) PA NSO PA NSO; QL (30 per 30 days) PA NSO; QL (90 per 30 days) PA NSO; QL (60 per 30 days) PA NSO PA NSO; QL (21 per 28 days) PA NSO; QL (60 per 30 days) PA NSO; QL (30 per 30 days) PA NSO www.centersplan.com/fida/participants 31

IMLYGIC INJECTION SUSPENSION 10EXP6 (1 MILLION) PFU/ML IMLYGIC INJECTION SUSPENSION 10EXP8 (100 MILLION) PFU/ML INLYTA ORAL TABLET 1 MG INLYTA ORAL TABLET 5 MG IRESSA ORAL TABLET 250 MG IXEMPRA 15 MG KIT WITH DILUENT 15 MG IXEMPRA INTRAVENOUS RECON SOLN 45 MG JAKAFI ORAL TABLET 10 MG, 15 MG, 20 MG, 25 MG, 5 MG KEYTRUDA INTRAVENOUS RECON SOLN 50 MG KEYTRUDA INTRAVENOUS SOLUTION 100 MG/4 ML (25 MG/ML) KYPROLIS INTRAVENOUS RECON SOLN 60 MG LENVIMA ORAL CAPSULE 10 MG/DAY (10 MG X 1/DAY), 14 MG/DAY(10 MG X 1-4 MG X 1), 20 MG/DAY (10 MG X 2), 24 MG/DAY(10 MG X 2-4 MG X 1) letrozole oral tablet 2.5 mg (Femara) LEUKERAN ORAL TABLET 2 MG leuprolide subcutaneous kit 1 (Leuprolide mg/0.2 ml Acetate) lipodox intravenous suspension 2 mg/ml (Doxil) PA NSO; QL (4 per 365 days) PA NSO; QL (8 per 28 days) PA NSO; QL (180 per 30 days) PA NSO; QL (60 per 30 days) PA NSO; QL (60 per 30 days) PA NSO; QL (60 per 30 days) PA NSO PA NSO PA NSO; QL (6 per 28 days) PA NSO www.centersplan.com/fida/participants 32

lomustine oral capsule 10 mg, 100 mg, 40 mg LONSURF ORAL TABLET 15-6.14 MG LONSURF ORAL TABLET 20-8.19 MG LUPRON DEPOT (3 MONTH) INTRAMUSCULAR SYRINGE KIT 11.25 MG, 22.5 MG LUPRON DEPOT (4 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG LUPRON DEPOT (6 MONTH) INTRAMUSCULAR SYRINGE KIT 45 MG LUPRON DEPOT INTRAMUSCULAR SYRINGE KIT 3.75 MG, 7.5 MG LYNPARZA ORAL CAPSULE 50 MG LYSODREN ORAL TABLET 500 MG MATULANE ORAL CAPSULE 50 MG megestrol oral tablet 20 mg, 40 mg MEKINIST ORAL TABLET 0.5 MG (Lomustine) (Megestrol Acetate) MEKINIST ORAL TABLET 2 MG mercaptopurine oral tablet 50 mg (Mercaptopurine) methotrexate 50 mg/2 ml vial latexfree, 5's, mdv 25 mg/ml Sodium) (Methotrexate methotrexate sodium (pf) injection (Methotrexate recon soln 1 gram Sodium/PF) methotrexate sodium (pf) injection (Methotrexate solution 25 mg/ml Sodium) PA NSO; QL (100 per 28 days) PA NSO; QL (80 per 28 days) QL (1 per 84 days) QL (1 per 84 days) QL (1 per 168 days) PA NSO; QL (480 per 30 days) PA NSO; QL (90 per 30 days) PA NSO; QL (30 per 30 days) www.centersplan.com/fida/participants 33

methotrexate sodium oral tablet 2.5 mg mitoxantrone intravenous concentrate 2 mg/ml NEXAVAR ORAL TABLET 200 MG NILANDRON ORAL TABLET 150 MG NINLARO ORAL CAPSULE 2.3 MG, 3 MG, 4 MG ODOMZO ORAL CAPSULE 200 MG ONCASPAR INJECTION SOLUTION 750 UNIT/ML OPDIVO INTRAVENOUS SOLUTION 40 MG/4 ML POMALYST ORAL CAPSULE 1 MG, 2 MG, 3 MG, 4 MG PORTRAZZA INTRAVENOUS SOLUTION 800 MG/50 ML (16 MG/ML) PROLEUKIN INTRAVENOUS RECON SOLN 22 MILLION UNIT PURIXAN ORAL SUSPENSION 20 MG/ML REVLIMID ORAL CAPSULE 10 MG, 15 MG, 2.5 MG, 20 MG, 25 MG, 5 MG RITUXAN INTRAVENOUS CONCENTRATE 10 MG/ML SOLTAMOX ORAL SOLUTION 10 MG/5 ML SPRYCEL ORAL TABLET 100 MG, 140 MG, 50 MG, 70 MG, 80 MG (Methotrexate Sodium) (Mitoxantrone HCl) SPRYCEL ORAL TABLET 20 MG ; ST PA NSO; QL (120 per 30 days) PA NSO; QL (3 per 28 days) PA NSO; LA PA NSO PA NSO PA NSO; QL (21 per 28 days) PA NSO; QL (100 per 21 days) PA NSO; LA PA NSO PA NSO; QL (30 per 30 days) PA NSO; QL (60 per 30 days) www.centersplan.com/fida/participants 34

STIVARGA ORAL TABLET 40 MG SUTENT ORAL CAPSULE 12.5 MG, 25 MG, 37.5 MG, 50 MG SYLVANT INTRAVENOUS RECON SOLN 100 MG, 400 MG SYNRIBO SUBCUTANEOUS RECON SOLN 3.5 MG TABLOID ORAL TABLET 40 MG TAFINLAR ORAL CAPSULE 50 MG, 75 MG TAGRISSO ORAL TABLET 40 MG, 80 MG tamoxifen oral tablet 10 mg, 20 mg (Tamoxifen Citrate) TARCEVA ORAL TABLET 100 MG, 25 MG TARCEVA ORAL TABLET 150 MG TARGRETIN ORAL CAPSULE 75 MG TARGRETIN TOPICAL GEL 1 % TASIGNA ORAL CAPSULE 150 MG, 200 MG TECENTRIQ INTRAVENOUS SOLUTION 1,200 MG/20 ML (60 MG/ML) TEMODAR INTRAVENOUS RECON SOLN 100 MG thiotepa injection recon soln 15 mg (Thiotepa) toposar intravenous solution 20 mg/ml (Etoposide) TREANDA 25 MG VIAL 25 MG TREANDA INTRAVENOUS RECON SOLN 100 MG PA NSO; QL (84 per 28 days) PA NSO; QL (30 per 30 days) PA NSO PA NSO; QL (28 per 28 days) PA NSO; QL (120 per 30 days) PA NSO; LA; QL (30 per 30 days) PA NSO; QL (60 per 30 days) PA NSO; QL (90 per 30 days) PA NSO; QL (420 per 30 days) PA NSO; QL (60 per 28 days) PA NSO; QL (112 per 28 days) PA NSO; QL (20 per 21 days) PA NSO; (vial only) www.centersplan.com/fida/participants 35

TREANDA INTRAVENOUS SOLUTION 180 MG/2 ML, 45 MG/0.5 ML TRELSTAR 22.5 MG SYRINGE WITH MIXJECT 22.5 MG/2 ML TRELSTAR INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 22.5 MG TRELSTAR INTRAMUSCULAR SYRINGE 11.25 MG/2 ML TRELSTAR INTRAMUSCULAR SYRINGE 3.75 MG/2 ML tretinoin (chemotherapy) oral capsule 10 mg (Tretinoin) TREXALL ORAL TABLET 10 MG, 15 MG, 5 MG, 7.5 MG TYKERB ORAL TABLET 250 MG UNITUXIN INTRAVENOUS SOLUTION 3.5 MG/ML VALSTAR INTRAVESICAL SOLUTION 40 MG/ML VELCADE INJECTION RECON SOLN 3.5 MG VENCLEXTA ORAL TABLET 10 MG, 100 MG, 50 MG VENCLEXTA STARTING PACK ORAL TABLETS,DOSE PACK 10 MG-50 MG- 100 MG vinorelbine intravenous solution 50 mg/5 ml (Navelbine) VOTRIENT ORAL TABLET 200 MG XALKORI ORAL CAPSULE 200 MG, 250 MG XTANDI ORAL CAPSULE 40 MG QL (1 per 168 days) QL (1 per 168 days) QL (1 per 84 days) (capsule: 10mg) ; ST PA NSO PA NSO PA NSO; LA PA NSO; LA PA NSO; QL (120 per 30 days) PA NSO; QL (60 per 30 days) PA NSO; QL (120 per 30 days) www.centersplan.com/fida/participants 36

YERVOY INTRAVENOUS SOLUTION 50 MG/10 ML (5 MG/ML) YONDELIS INTRAVENOUS RECON SOLN 1 MG ZELBORAF ORAL TABLET 240 MG ZOLADEX SUBCUTANEOUS IMPLANT 10.8 MG ZOLADEX SUBCUTANEOUS IMPLANT 3.6 MG ZOLINZA ORAL CAPSULE 100 MG ZYDELIG ORAL TABLET 100 MG, 150 MG ZYKADIA ORAL CAPSULE 150 MG ZYTIGA ORAL TABLET 250 MG Anticholinergic Agents Antimuscarinics/Antispasm odics atropine injection solution 0.4 mg/ml atropine injection syringe 0.05 mg/ml, 0.1 mg/ml propantheline oral tablet 15 mg STIOLTO RESPIMAT INHALATION MIST 2.5-2.5 MCG/ACTUATION Anticonvulsants Anticonvulsants APTIOM ORAL TABLET 200 MG, 400 MG, 600 MG, 800 MG BANZEL ORAL SUSPENSION 40 MG/ML (Atropine Sulfate) (Atropine Sulfate) (Propantheline Bromide) PA NSO PA NSO PA NSO; QL (240 per 30 days) QL (1 per 84 days) QL (1 per 28 days) PA NSO; QL (60 per 30 days) PA NSO; QL (140 per 28 days) PA NSO; QL (120 per 30 days) QL (4 per 28 days) ST ST www.centersplan.com/fida/participants 37

BANZEL ORAL TABLET 200 MG, 400 MG BRIVIACT INTRAVENOUS SOLUTION 50 MG/5 ML BRIVIACT ORAL SOLUTION 10 MG/ML BRIVIACT ORAL TABLET 10 MG, 100 MG, 25 MG, 50 MG, 75 MG carbamazepine oral capsule, er multiphase 12 hr 100 mg, 200 mg, (Carbatrol) 300 mg carbamazepine oral suspension 100 mg/5 ml (Tegretol) carbamazepine oral tablet 200 mg (Tegretol) carbamazepine oral tablet extended release 12 hr 100 mg, 200 mg, 400 (Tegretol XR) mg carbamazepine oral tablet,chewable 100 mg (Carbamazepine) CELONTIN ORAL CAPSULE 300 MG DILANTIN ORAL CAPSULE 30 MG divalproex oral capsule, sprinkle (Depakote 125 mg Sprinkle) divalproex oral tablet extended release 24 hr 250 mg, 500 mg (Depakote ER) divalproex oral tablet,delayed release (dr/ec) 125 mg, 250 mg, 500 (Depakote) mg epitol oral tablet 200 mg (Tegretol) ethosuximide oral capsule 250 mg (Zarontin) ethosuximide oral solution 250 mg/5 ml (Zarontin) felbamate oral suspension 600 mg/5 ml (Felbatol) ST PA NSO; QL (80 per 30 days) PA NSO; QL (600 per 30 days) PA NSO; QL (60 per 30 days) www.centersplan.com/fida/participants 38

felbamate oral tablet 400 mg, 600 mg fosphenytoin 500 mg pe/10 ml 10's,sdv,latex-free 500 mg pe/10 ml fosphenytoin injection solution 100 mg pe/2 ml FYCOMPA ORAL TABLET 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG gabapentin oral capsule 100 mg, 300 mg, 400 mg gabapentin oral solution 250 mg/5 ml gabapentin oral tablet 600 mg, 800 mg GABITRIL ORAL TABLET 12 MG, 16 MG LAMICTAL ORAL TABLET, CHEWABLE DISPERSIBLE 2 MG lamotrigine oral tablet 100 mg, 150 mg, 200 mg, 25 mg lamotrigine oral tablet extended release 24hr 100 mg, 200 mg, 25 mg, 250 mg, 300 mg, 50 mg lamotrigine oral tablet, chewable dispersible 25 mg, 5 mg lamotrigine oral tablets,dose pack 25 mg (35) levetiracetam intravenous solution 500 mg/5 ml levetiracetam oral solution 100 mg/ml levetiracetam oral tablet 1,000 mg, 250 mg, 500 mg, 750 mg levetiracetam oral tablet extended release 24 hr 500 mg, 750 mg (Felbatol) (Cerebyx) (Cerebyx) (Neurontin) (Neurontin) (Neurontin) (Lamictal) (Lamictal XR) (Lamictal) (Lamictal (Blue)) (Keppra) (Keppra) (Keppra) (Keppra XR) ST www.centersplan.com/fida/participants 39

LYRICA ORAL CAPSULE 100 QL (90 per 30 days) MG, 150 MG, 200 MG, 225 MG, 25 MG, 300 MG, 50 MG, 75 MG LYRICA ORAL SOLUTION 20 QL (900 per 30 days) MG/ML oxcarbazepine oral suspension 300 mg/5 ml (Trileptal) oxcarbazepine oral tablet 150 mg, 300 mg, 600 mg (Trileptal) OXTELLAR XR ORAL TABLET ST EXTENDED RELEASE 24 HR 150 MG, 300 MG, 600 MG PEGANONE ORAL TABLET 250 MG phenobarbital oral elixir 20 mg/5 ml QL (1500 per 30 days) (Phenobarbital) (4 mg/ml) phenobarbital oral tablet 100 mg, QL (90 per 30 days) 15 mg, 16.2 mg, 32.4 mg, 60 mg, 64.8 mg, 97.2 mg (Phenobarbital) phenobarbital oral tablet 30 mg (Phenobarbital) QL (200 per 30 days) phenobarbital sodium injection (Phenobarbital QL (2 per 30 days) solution 130 mg/ml, 65 mg/ml Sodium) phenytoin oral suspension 125 mg/5 ml (Dilantin-125) phenytoin oral tablet,chewable 50 mg (Dilantin) phenytoin sodium extended oral capsule 100 mg, 200 mg, 300 mg (Dilantin) phenytoin sodium intravenous (Phenytoin solution 50 mg/ml Sodium) phenytoin sodium intravenous (Phenytoin syringe 50 mg/ml Sodium) POTIGA ORAL TABLET 200 MG, QL (90 per 30 days) 300 MG, 400 MG POTIGA ORAL TABLET 50 MG QL (270 per 30 days) primidone oral tablet 250 mg, 50 mg (Mysoline) SABRIL ORAL POWDER IN PACKET 500 MG www.centersplan.com/fida/participants 40

SABRIL ORAL TABLET 500 MG SPRITAM ORAL TABLET FOR SUSPENSION 1,000 MG SPRITAM ORAL TABLET FOR SUSPENSION 250 MG, 500 MG, 750 MG tiagabine oral tablet 2 mg, 4 mg (Gabitril) topiragen oral tablet 100 mg, 200 mg, 25 mg, 50 mg (Topamax) topiramate oral capsule, sprinkle 15 mg, 25 mg (Topamax) topiramate oral capsule,sprinkle,er 24hr 100 mg, 150 mg, 200 mg, 25 (Qudexy XR) mg, 50 mg topiramate oral tablet 100 mg, 200 mg, 25 mg, 50 mg (Topamax) TROKENDI XR ORAL CAPSULE,EXTENDED RELEASE 24HR 100 MG, 200 MG, 25 MG, 50 MG valproate sodium intravenous solution 500 mg/5 ml (100 mg/ml) (Depacon) valproic acid (as sodium salt) oral solution 250 mg/5 ml (Depakene) valproic acid oral capsule 250 mg (Depakene) VIMPAT INTRAVENOUS SOLUTION 200 MG/20 ML VIMPAT ORAL SOLUTION 10 MG/ML VIMPAT ORAL TABLET 100 MG, 150 MG, 200 MG, 50 MG zonisamide oral capsule 100 mg, 25 mg, 50 mg (Zonegran) Antidementia Agents Antidementia Agents donepezil oral tablet 10 mg, 23 mg, 5 mg (Aricept) ST; QL (60 per 30 days) ST; QL (120 per 30 days) ST QL (200 per 5 days) QL (1200 per 30 days) QL (60 per 30 days) QL (30 per 30 days) www.centersplan.com/fida/participants 41

donepezil oral tablet,disintegrating QL (30 per 30 days) (Donepezil HCl) 10 mg, 5 mg galantamine oral capsule,ext rel. QL (30 per 30 days) (Razadyne ER) pellets 24 hr 16 mg, 24 mg, 8 mg galantamine oral solution 4 mg/ml (Galantamine Hbr) QL (200 per 30 days) galantamine oral tablet 12 mg, 4 QL (60 per 30 days) (Razadyne) mg, 8 mg memantine oral solution 2 mg/ml (Namenda) QL (360 per 30 days) memantine oral tablet 10 mg, 5 mg (Namenda) QL (60 per 30 days) memantine oral tablets,dose pack 5- QL (49 per 28 days) (Namenda) 10 mg NAMENDA XR ORAL QL (28 per 28 days) CAP,SPRINKLE,ER 24HR DOSE PACK 7-14-21-28 MG NAMENDA XR ORAL QL (30 per 30 days) CAPSULE,SPRINKLE,ER 24HR 14 MG, 21 MG, 28 MG, 7 MG NAMZARIC ORAL CAPSULE,SPRINKLE,ER 24HR 14-10 MG, 28-10 MG rivastigmine tartrate oral capsule QL (60 per 30 days) (Exelon) 1.5 mg, 3 mg, 4.5 mg, 6 mg rivastigmine transdermal patch 24 QL (30 per 30 days) hour 13.3 mg/24 hour, 4.6 mg/24 hr, 9.5 mg/24 hr (Exelon) Antidepressants Antidepressants amitriptyline oral tablet 10 mg, 100 (Amitriptyline PA NSO-HRM mg, 150 mg, 25 mg, 50 mg, 75 mg HCl) amoxapine oral tablet 100 mg, 150 mg, 25 mg, 50 mg (Amoxapine) BRINTELLIX ORAL TABLET 10 ST MG, 20 MG, 5 MG buproban oral tablet extended release 150 mg (Wellbutrin SR) bupropion hcl oral tablet 100 mg, 75 mg (Wellbutrin) www.centersplan.com/fida/participants 42

bupropion hcl oral tablet extended release 100 mg, 150 mg, 200 mg (Wellbutrin SR) bupropion hcl oral tablet extended release 24 hr 150 mg, 300 mg (Wellbutrin XL) citalopram oral solution 10 mg/5 ml (Citalopram Hydrobromide) citalopram oral tablet 10 mg, 20 QL (30 per 30 days) (Celexa) mg, 40 mg clomipramine oral capsule 25 mg, PA NSO-HRM (Anafranil) 50 mg, 75 mg desipramine oral tablet 10 mg, 100 mg, 150 mg, 25 mg, 50 mg, 75 mg (Norpramin) doxepin oral capsule 10 mg, 100 PA NSO-HRM (Doxepin HCl) mg, 150 mg, 25 mg, 50 mg, 75 mg doxepin oral concentrate 10 mg/ml (Doxepin HCl) PA NSO-HRM duloxetine oral capsule,delayed (Cymbalta); QL (60 (Duloxetine) release(dr/ec) 20 mg, 60 mg per 30 days) duloxetine oral capsule,delayed (Cymbalta); QL (30 (Duloxetine) release(dr/ec) 30 mg per 30 days) duloxetine oral capsule,delayed (Irenka); QL (30 per 30 (Duloxetine) release(dr/ec) 40 mg days) EMSAM TRANSDERMAL QL (30 per 30 days) PATCH 24 HOUR 12 MG/24 HR, 6 MG/24 HR, 9 MG/24 HR escitalopram oxalate oral solution 5 mg/5 ml (Lexapro) escitalopram oxalate oral tablet 10 mg, 20 mg, 5 mg (Lexapro) FETZIMA ORAL CAPSULE,EXT ST REL 24HR DOSE PACK 20 MG (2)- 40 MG (26) FETZIMA ORAL ST CAPSULE,EXTENDED RELEASE 24 HR 120 MG, 20 MG, 40 MG, 80 MG fluoxetine oral capsule 10 mg, 20 mg, 40 mg (Prozac) www.centersplan.com/fida/participants 43

fluoxetine oral capsule,delayed release(dr/ec) 90 mg (Prozac Weekly) fluoxetine oral solution 20 mg/5 ml (4 mg/ml) (Fluoxetine HCl) fluoxetine oral tablet 10 mg, 20 mg (Fluoxetine HCl) fluvoxamine oral capsule,extended (Fluvoxamine release 24hr 100 mg, 150 mg Maleate) fluvoxamine oral tablet 100 mg, 25 (Fluvoxamine mg, 50 mg Maleate) imipramine hcl oral tablet 10 mg, 25 (Tofranil) mg, 50 mg imipramine pamoate oral capsule 100 mg, 125 mg, 150 mg, 75 mg (Tofranil-Pm) maprotiline oral tablet 25 mg, 50 mg, 75 mg (Maprotiline HCl) MARPLAN ORAL TABLET 10 MG mirtazapine oral tablet 15 mg, 30 mg, 45 mg, 7.5 mg (Remeron) mirtazapine oral tablet,disintegrating 15 mg, 30 mg, (Remeron) 45 mg nefazodone oral tablet 100 mg, 150 mg, 200 mg, 250 mg, 50 mg (Nefazodone HCl) nortriptyline oral capsule 10 mg, 25 mg, 50 mg, 75 mg (Pamelor) nortriptyline oral solution 10 mg/5 ml (Nortriptyline HCl) olanzapine-fluoxetine oral capsule 12-25 mg, 12-50 mg, 3-25 mg, 6-25 (Symbyax) mg, 6-50 mg paroxetine hcl oral tablet 10 mg, 20 mg, 30 mg, 40 mg (Paxil) paroxetine hcl oral tablet extended release 24 hr 12.5 mg, 25 mg, 37.5 (Paxil CR) mg PAXIL ORAL SUSPENSION 10 MG/5 ML PA NSO-HRM PA NSO-HRM www.centersplan.com/fida/participants 44

perphenazine-amitriptyline oral tablet 2-10 mg, 2-25 mg, 4-10 mg, 4-25 mg, 4-50 mg (Perphenazine/Ami triptyline HCl) phenelzine oral tablet 15 mg (Nardil) PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 100 MG, 25 MG, 50 MG protriptyline oral tablet 10 mg, 5 mg (Protriptyline HCl) sertraline oral concentrate 20 mg/ml (Zoloft) sertraline oral tablet 100 mg, 25 mg, 50 mg (Zoloft) SILENOR ORAL TABLET 3 MG, 6 MG SURMONTIL ORAL CAPSULE 100 MG, 25 MG, 50 MG tranylcypromine oral tablet 10 mg (Parnate) trazodone oral tablet 100 mg, 150 mg, 300 mg, 50 mg (Trazodone HCl) trimipramine oral capsule 100 mg, (Trimipramine 25 mg, 50 mg Maleate) TRINTELLIX ORAL TABLET 10 MG, 20 MG, 5 MG venlafaxine oral capsule,extended release 24hr 150 mg, 37.5 mg, 75 (Effexor XR) mg venlafaxine oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg venlafaxine oral tablet extended release 24hr 150 mg, 37.5 mg, 75 mg VIIBRYD ORAL TABLET 10 MG, 20 MG, 40 MG VIIBRYD ORAL TABLETS,DOSE PACK 10 MG (7)- 20 MG (23), 10 MG (7)-20 MG (7)-40 MG (16) Antidiabetic Agents (Venlafaxine HCl) (Venlafaxine HCl) PA NSO-HRM ST; QL (30 per 30 days) QL (30 per 30 days) PA NSO-HRM PA NSO-HRM ST www.centersplan.com/fida/participants 45

Antidiabetic Agents, Miscellaneous acarbose oral tablet 100 mg, 25 mg, 50 mg CYCLOSET ORAL TABLET 0.8 MG GLYXAMBI ORAL TABLET 10-5 MG, 25-5 MG INVOKAMET ORAL TABLET 150-1,000 MG, 150-500 MG, 50-1,000 MG, 50-500 MG INVOKANA ORAL TABLET 100 MG, 300 MG JANUMET ORAL TABLET 50-1,000 MG, 50-500 MG JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 100-1,000 MG, 50-1,000 MG, 50-500 MG JANUVIA ORAL TABLET 100 MG, 25 MG, 50 MG JARDIANCE ORAL TABLET 10 MG, 25 MG JENTADUETO ORAL TABLET 2.5-1,000 MG, 2.5-500 MG, 2.5-850 MG KORLYM ORAL TABLET 300 (Precose) QL (90 per 30 days) QL (180 per 30 days) ST ST ST ST PA; QL (112 per 28 days) MG metformin oral tablet 1,000 mg (Glucophage) QL (75 per 30 days) metformin oral tablet 500 mg (Glucophage) QL (150 per 30 days) metformin oral tablet 850 mg (Glucophage) QL (90 per 30 days) metformin oral tablet extended release 24 hr 500 mg metformin oral tablet extended release 24 hr 750 mg metformin oral tablet extended release 24hr 1,000 mg (Glucophage XR) (Glucophage XR) (Fortamet) QL (120 per 30 days) QL (90 per 30 days) QL (60 per 30 days) www.centersplan.com/fida/participants 46

metformin oral tablet extended release 24hr 500 mg miglitol oral tablet 100 mg, 25 mg, 50 mg nateglinide oral tablet 120 mg, 60 mg pioglitazone oral tablet 15 mg, 30 mg, 45 mg pioglitazone-glimepiride oral tablet 30-2 mg, 30-4 mg pioglitazone-metformin oral tablet 15-500 mg, 15-850 mg repaglinide oral tablet 0.5 mg, 1 mg, 2 mg repaglinide-metformin oral tablet 1-500 mg, 2-500 mg SYMLINPEN 120 SUBCUTANEOUS PEN INJECTOR 2,700 MCG/2.7 ML SYMLINPEN 60 SUBCUTANEOUS PEN INJECTOR 1,500 MCG/1.5 ML SYNJARDY ORAL TABLET 12.5-1,000 MG, 12.5-500 MG, 5-1,000 MG, 5-500 MG TRADJENTA ORAL TABLET 5 MG TRULICITY SUBCUTANEOUS PEN INJECTOR 0.75 MG/0.5 ML, 1.5 MG/0.5 ML VICTOZA 3-PAK SUBCUTANEOUS PEN INJECTOR 0.6 MG/0.1 ML (18 MG/3 ML) Insulins HUMULIN R U-500 (CONC) KWIKPEN SUBCUTANEOUS INSULIN PEN 500 UNIT/ML (3 ML) (Fortamet) (Glyset) (Starlix) (Actos) (Duetact) (Actoplus Met) (Prandin) (Prandimet) QL (150 per 30 days) QL (90 per 30 days) QL (90 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (90 per 30 days) QL (240 per 30 days) QL (150 per 30 days) PA; QL (10.8 per 28 days) PA; QL (6 per 28 days) ST QL (24 per 28 days) www.centersplan.com/fida/participants 47

HUMULIN R U-500 QL (40 per 28 days) (CONCENTRATED) SUBCUTANEOUS SOLUTION 500 UNIT/ML LANTUS SOLOSTAR SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (3 ML) LANTUS SUBCUTANEOUS SOLUTION 100 UNIT/ML NOVOLIN 70/30 QL (40 per 28 days) SUBCUTANEOUS SUSPENSION 100 UNIT/ML (70-30) NOVOLIN N SUBCUTANEOUS QL (40 per 28 days) SUSPENSION 100 UNIT/ML NOVOLIN R INJECTION QL (40 per 28 days) SOLUTION 100 UNIT/ML NOVOLOG FLEXPEN QL (30 per 28 days) SUBCUTANEOUS INSULIN PEN 100 UNIT/ML NOVOLOG MIX 70-30 FLEXPEN QL (30 per 28 days) SUBCUTANEOUS INSULIN PEN 100 UNIT/ML (70-30) NOVOLOG MIX 70-30 QL (40 per 28 days) SUBCUTANEOUS SOLUTION 100 UNIT/ML (70-30) NOVOLOG PENFILL QL (30 per 28 days) SUBCUTANEOUS CARTRIDGE 100 UNIT/ML NOVOLOG SUBCUTANEOUS QL (40 per 28 days) SOLUTION 100 UNIT/ML TOUJEO SOLOSTAR SUBCUTANEOUS INSULIN PEN 300 UNIT/ML (1.5 ML) Sulfonylureas glimepiride oral tablet 1 mg, 2 mg (Amaryl) QL (30 per 30 days) glimepiride oral tablet 4 mg (Amaryl) QL (60 per 30 days) glipizide oral tablet 10 mg (Glucotrol) QL (120 per 30 days) glipizide oral tablet 5 mg (Glucotrol) QL (60 per 30 days) www.centersplan.com/fida/participants 48

glipizide oral tablet extended release 24hr 10 mg glipizide oral tablet extended release 24hr 2.5 mg glipizide oral tablet extended release 24hr 5 mg glipizide-metformin oral tablet 2.5-250 mg glipizide-metformin oral tablet 2.5-500 mg, 5-500 mg glyburide micronized oral tablet 1.5 mg glyburide micronized oral tablet 3 mg glyburide micronized oral tablet 6 mg (Glucotrol XL) (Glucotrol XL) (Glipizide/Metform in HCl) (Glipizide/Metform in HCl) (Glynase) (Glynase) (Glynase) glyburide oral tablet 1.25 mg (Glyburide) glyburide oral tablet 2.5 mg (Glyburide) glyburide oral tablet 5 mg (Glyburide) QL (60 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (240 per 30 days) QL (120 per 30 days) PA-HRM; QL (400 per 30 days) PA-HRM; QL (180 per 30 days) PA-HRM; QL (120 per 30 days) PA-HRM; QL (280 per 30 days) PA-HRM; QL (240 per 30 days) PA-HRM; QL (120 per 30 days) PA-HRM; QL (240 per 30 days) PA-HRM; QL (120 per 30 days) glyburide-metformin oral tablet 1.25-250 mg (Glucovance) glyburide-metformin oral tablet 2.5-500 mg, 5-500 mg (Glucovance) tolazamide oral tablet 250 mg (Tolazamide) QL (120 per 30 days) tolazamide oral tablet 500 mg (Tolazamide) QL (60 per 30 days) tolbutamide oral tablet 500 mg (Tolbutamide) QL (180 per 30 days) Antifungals Antifungals ABELCET INTRAVENOUS SUSPENSION 5 MG/ML aloe vesta 2% antifungal oint 2 % * AMBISOME INTRAVENOUS SUSPENSION FOR RECONSTITUTION 50 MG (Miconazole Nitrate) www.centersplan.com/fida/participants 49

amphotericin b injection recon soln (Amphotericin B) 50 mg anti-fungal 1% powder 1 % * (Tolnaftate) baza antifungal 2% cream 12's 2 % (Nuzole) * blis-to-sol 1% liquid 1 % * (Tolnaftate) CANCIDAS INTRAVENOUS RECON SOLN 50 MG, 70 MG ciclopirox topical cream 0.77 % (Ciclodan) ciclopirox topical gel 0.77 % (Loprox) ciclopirox topical shampoo 1 % (Loprox) ciclopirox topical solution 8 % (Penlac) ciclopirox topical suspension 0.77 (Ciclopirox % Olamine) ciclopirox-ure-camph-menth-euc (Ciclodan) topical solution 8 % clotrim 1% vaginal cream 1 % * (Gyne-Lotrimin) clotrimazole 1% cream (otc) 1 % * (Lotrimin AF) clotrimazole 1% solution (otc) 1 % (Clotrimazole) * clotrimazole insert 100 mg * (Clotrimazole) clotrimazole mucous membrane (Clotrimazole) troche 10 mg clotrimazole topical cream 1 % (Clotrimazole) clotrimazole topical solution 1 % (Clotrimazole) clotrimazole-7 cream 1 % * (Gyne-Lotrimin) clotrimazole-betamethasone topical (Lotrisone) cream 1-0.05 % cvs 3-day vaginal cream 2 % * (Gyne-Lotrimin) cvs af 1% spray powder 1 % * (Tinactin) cvs antifungal 25% liquid 25 % * (Undecylenic Acid) clotrimazole-betamethasone topical critic-aid clear af 2% oint 12's, w/ (Clotrimazole/Beta (Miconazole lotion 1-0.05 % antifungal 2 % * methasone Dip) Nitrate) www.centersplan.com/fida/participants 50

cvs miconazole 3 combo pack 3pref applic w/cream 4 % (200 mg)- 2 % (9 gram) * (Miconazole Nitrate) dermafungal 2% ointment 2 % * (Miconazole Nitrate) econazole topical cream 1 % (Econazole Nitrate) elon dual defense 25% solution 25 % * (Undecylenic Acid) fluconazole in dextrose(iso-o) (Fluconazole In intravenous piggyback 400 mg/200 Nacl,Iso-Osm) ml fluconazole in nacl (iso-osm) intravenous piggyback 100 mg/50 ml, 200 mg/100 ml (Fluconazole In Nacl,Iso-Osm) fluconazole oral suspension for reconstitution 10 mg/ml, 40 mg/ml (Diflucan) fluconazole oral tablet 100 mg, 150 mg, 200 mg, 50 mg (Diflucan) fluconazole-nacl 400 mg/200 ml (Fluconazole In 10's,latex-free, p/f 400 mg/200 ml Nacl,Iso-Osm) flucytosine oral capsule 250 mg, 500 mg (Ancobon) fungi cure intensive 1% spray 1 % * (Clotrimazole) FUNGI-NAIL TINCTURE * fungoid-d 1% cream 1 % * (Tinactin) gnp miconazole 3 combo pack 4 % (Miconazole (200 mg)- 2 % (9 gram) * Nitrate) griseofulvin microsize oral tablet 500 mg (Grifulvin V) inzo antifungal 2% cream 2 % * (Nuzole) itraconazole oral capsule 100 mg (Sporanox) ketoconazole oral tablet 200 mg (Ketoconazole) ketoconazole topical cream 2 % (Ketoconazole) ketoconazole topical shampoo 2 % (Nizoral) lamisil af defens 1% spray pwd 1 % * (Tinactin) lamisil af defense 1% powder 1 % * (Tolnaftate) www.centersplan.com/fida/participants 51

LAMISIL ANTIFUNGAL 1% SPRAY FOR ATHLETES FOOT 1 % * LAMISIL AT 1% GEL 1 % * micatin 2% antifungal cream 2 % * (Nuzole) miconazole 3 combo pack 3 sup,9gm (Monistat 3) crm w/app 200 mg- 2 % (9 gram) * miconazole 7 100 mg vag supp 100 (Miconazole mg * Nitrate) miconazole nitrate 2% cream 2 % * (Nuzole) (Miconazole miconazole nitrate 2% cream 2 % * Nitrate) miconazole-3 vaginal suppository (Miconazole 200 mg Nitrate) MONISTAT 3 COMBO PACK 3 SUPP, 9 GM CREAM 200 MG- 2 % (9 GRAM) * MONISTAT 3 COMBO PACK 4 % (200 MG)- 2 % (9 GRAM) * monistat 7 cream 7 applicators 2 % (Miconazole * Nitrate) myco nail a 25% solution 25 % * (Undecylenic Acid) NOXAFIL ORAL SUSPENSION 200 MG/5 ML (40 MG/ML) NOXAFIL ORAL TABLET,DELAYED RELEASE (DR/EC) 100 MG nyamyc topical powder 100,000 (Nystatin) unit/gram nystatin oral suspension 100,000 (Nystatin) unit/ml nystatin oral tablet 500,000 unit (Nystatin) nystatin topical cream 100,000 (Nystatin) unit/gram nystatin topical ointment 100,000 (Nystatin) unit/gram nystatin topical powder 100,000 (Nystatin) unit/gram www.centersplan.com/fida/participants 52

nystatin-triamcinolone topical (Nystatin/Triamcin cream 100,000-0.1 unit/g-% ) nystatin-triamcinolone topical (Nystatin/Triamcin ointment 100,000-0.1 unit/gram-% ) nystop topical powder 100,000 (Nystatin) unit/gram pv foot odor control 1% powder 1 % (Tinactin) * qc 3 day vaginal 4% cream 200 (Miconazole mg/5 gram (4 %) * Nitrate) ra antifungal 1% liquid spray liquid (Tolnaftate) spray 1 % * remedy phytplx antifungal oint 2 % (Miconazole * Nitrate) terbinafine 1% cream 1 % * (Lamisil At) terbinafine hcl oral tablet 250 mg (Lamisil) tolnaftate 1% cream 1 % * (Tinactin) tolnaftate 1% solution 1 % * (Tolnaftate) (Miconazole triple paste af 2% ointment 2 % * Nitrate) voriconazole intravenous solution (Vfend IV) 200 mg voriconazole oral suspension for reconstitution 200 mg/5 ml (40 (Vfend) mg/ml) voriconazole oral tablet 200 mg, 50 (Vfend) mg Antihistamines Antihistamines alavert 10 mg odt non-drowsy, mint (Claritin) 10 mg * ALLEGRA ALLERGY 180 MG TABLET 180 MG * ALLEGRA ALLERGY 60 MG TABLET 60 MG * alavert d-12 allergy-sinus tab 5-120 (Claritin-D 12 mg * Hour) www.centersplan.com/fida/participants 53

aller-chlor 2 mg/5 ml syrup 2 mg/5 (Chlorpheniramine ml * Maleate) aller-chlor 4 mg tablet 4 mg * (Chlor-Trimeton) allerclear d-12hr tablet 5-120 mg * (Claritin-D 12 Hour) allerclear d-24hr er tablet nondrowsy 10-240 mg * Hour) (Claritin-D 24 allergy 4 mg tablet 4 mg * (Chlor-Trimeton) allerhist-1 1.34 mg tablet 1.34 mg * (Clemastine Fumarate) aller-tec d 5-120 mg tablet 5-120 mg * (Zyrtec-D) ambi 60pse-4cpm tablet 4-60 mg * (Chlorpheniramine/ Pseudoephed) aprodine tablet 2.5-60 mg * (Triprolidine/Pseud oephedrine) banophen 25 mg capsule 25 mg * (Zzzquil) banophen 25 mg tablet 25 mg * (Diphenhydramine HCl) banophen allergy 12.5 mg/5 ml a/f 12.5 mg/5 ml * (Zzzquil) benadryl allergy 25 mg ultratb (Diphenhydramine ultratab 25 mg * HCl) cetirizine hcl 1 mg/1 ml soln children, s/f, grape (otc) 1 mg/ml * (Children'S Zyrtec) cetirizine hcl 10 mg tablet indoor & outdoor 10 mg * (Zyrtec) cetirizine hcl 5 mg chew tab children's,outer,u-d 5 mg * (Zyrtec) cetirizine-pse er 5-120 mg tab 5-120 mg * (Zyrtec-D) child allegra allergy 30 mg/5 ml (Fexofenadine suspension 30 mg/5 ml * HCl) CHILD CLARITIN 5 MG/5 ML SOLN A/F,D/F,S/F,GRAPE 5 MG/5 ML * child triaminic cold & allergy 1-2.5 mg/5 ml * (Dimetapp) www.centersplan.com/fida/participants 54

child wal-tap cold-allergy elx 1-2.5 mg/5 ml * CHILD ZYRTEC 1 MG/ML SOLUTION D/F,S/F,GRAPE 1 MG/ML * children's allegra allergy oral tablet 30 mg * CHILDREN'S ZYRTEC 10 MG ODT 10 MG * child's aller-tec 1 mg/ml soln 1 mg/ml * CHILD'S CLARITIN 5 MG TAB CHEW 5 MG * child's wal-dryl 12.5 mg/5 ml a/f,s/f,d/f,bubb gum 12.5 mg/5 ml * child's wal-zyr 10 mg chew tab 10 mg * CLARITIN 10 MG LIQUI-GEL CAP 10 MG * CLARITIN 10 MG REDITABS 10 MG * CLARITIN 10 MG TABLET (OTC) 10 MG * CLARITIN 5 MG REDITABS 5 MG * clemastine fum 1.34 mg tablet (otc) 1.34 mg * cold-allergy-sinus oral tablet 2.5-60 mg * compoz 25 mg gelcap 25 mg * cvs allergy 25 mg tablet 25 mg * cvs allergy relief 10 mg sftgl 10 mg * cvs child allergy 10 mg chw tb 24 hr,indoor/outdoor 10 mg * (Dimetapp) (Allegra Allergy) (Children'S Zyrtec) (Zzzquil) (Zyrtec) (Clemastine Fumarate) (Triprolidine/Pseud oephedrine) (Diphenhydramine HCl) (Diphenhydramine HCl) (Zyrtec) (Zyrtec) www.centersplan.com/fida/participants 55

cvs cold & cough nighttime liq 6.25-2.5 mg/5 ml * cyproheptadine oral syrup 2 mg/5 ml cyproheptadine oral tablet 4 mg dailyhist-1 1.34 mg tablet 1.34 mg * dayhist allergy 1.34 mg tablet 12 hr relief 1.34 mg * dimaphen elixir a/f, grape, gluten-f 1-2.5 mg/5 ml * dimetapp cold & congest liquid 6.25-2.5 mg/5 ml * (Triaminic Nighttime Cold- Cough) (Cyproheptadine HCl) (Cyproheptadine HCl) (Clemastine Fumarate) (Clemastine Fumarate) (Dimetapp) (Triaminic Nighttime Cold- Cough) diphenhist 12.5 mg/5 ml soln 12.5 (Zzzquil) mg/5 ml * diphenhist 25 mg capsule 25 mg * (Zzzquil) diphenhist 25 mg captab captab 25 (Diphenhydramine mg * HCl) diphenhydramine 25 mg capsule (Zzzquil) (otc) 25 mg * diphenhydramine 50 mg capsule (Zzzquil) (otc) 50 mg * diphenhydramine 50 mg tablet 50 (Diphenhydramine mg * HCl) diphenhydramine hcl injection (Diphenhydramine solution 50 mg/ml HCl) (Chlorpheniramine ed chlorped jr syrup 2 mg/5 ml * Maleate) ed-a-hist 4 mg-10 mg tablet 4-10 mg (Chlorpheniramine/ * Phenylephrine) fexofenadine hcl 180 mg tablet (Allegra Allergy) 24hr,original str (otc) 180 mg * fexofenadine hcl 30 mg/5 ml 30 (Fexofenadine mg/5 ml * HCl) www.centersplan.com/fida/participants 56

fexofenadine hcl 60 mg tablet (Allegra Allergy) indoor/outdoor (otc) 60 mg * hm z-sleep 25 mg softgel 25 mg * (Zzzquil) levocetirizine oral solution 2.5 mg/5 (Xyzal) ml levocetirizine oral tablet 5 mg (Xyzal) loratadine 10 mg tablet 10 mg * (Claritin) loratadine allergy 5 mg/5 ml d/f, a/f, (Children'S s/f 5 mg/5 ml * Claritin) loratadine-d 12 hour tablet nondrowsy 5-120 mg * Hour) (Claritin-D 12 loratadine-d 24hr tablet 10-240 mg (Claritin-D 24 * Hour) q-dryl 12.5 mg/5 ml liquid a/f 12.5 (Zzzquil) mg/5 ml * ra sleep aid 50 mg/30 ml liq 50 (Zzzquil) mg/30 ml * siladryl 12.5 mg/5 ml liquid 12.5 (Zzzquil) mg/5 ml * (Doxylamine sleep aid 25 mg tablet 25 mg * Succinate) sm z-sleep 50 mg/30 ml liquid (Zzzquil) berry,gluten-free 50 mg/30 ml * TRIAMINIC NIGHTTIME COLD- COUGH CHILDREN'S, GRAPE 6.25-2.5 MG/5 ML * unisom 50 mg sleepgels softgel 50 (Zzzquil) mg * promethazine oral syrup 6.25 mg/5 pv nyt-time sleep 25 mg caplet 25 simply sleep 25 mg caplet caplet 25 sm sinus and allergy tablet sudogest sinus & allergy tab 4-60 (Promethazine (Diphenhydramine (Diphenhydramine (Chlorpheniramine/ (Chlorpheniramine/ ml mg * mg * maximum strength 4-60 mg * mg * HCl) HCl) HCl) Pseudoephed) Pseudoephed) PA-HRM www.centersplan.com/fida/participants 57

wal-act d cold & allergy tab 2.5-60 (Triprolidine/Pseud mg * oephedrine) wal-dryl allergy 25 mg capsule 25 (Zzzquil) mg * wal-dryl allergy 25 mg minitab (Diphenhydramine minitab, coated 25 mg * HCl) wal-fex allergy 180 mg tablet 180 (Allegra Allergy) mg * wal-fex allergy 60 mg tablet 60 mg * (Allegra Allergy) wal-finate 4 mg tablet 4 mg * (Chlor-Trimeton) (Chlorpheniramine/ wal-finate-d tablet 4-60 mg * Pseudoephed) wal-itin 10 mg odt non-drowsy 10 (Claritin) mg * wal-itin 10 mg tablet non-drowsy 10 (Claritin) mg * wal-itin 5 mg/5 ml syrup children's, (Children'S grape 5 mg/5 ml * Claritin) (Claritin-D 12 wal-itin d 12 hour tablet 5-120 mg * Hour) wal-itin d 24 hour tablet 10-240 mg (Claritin-D 24 * Hour) (Unisom wal-sleep z 25 mg odt 25 mg * Sleepmelts) wal-sleep z 25 mg softgel 25 mg * (Zzzquil) wal-sleep z 50 mg/30 ml liquid (Zzzquil) berry, a/f, d/f, s/f 50 mg/30 ml * (Doxylamine wal-som 25 mg tablet 25 mg * Succinate) wal-som 50 mg softgel softgel 50 mg (Zzzquil) * wal-tap elixir 1-2.5 mg/5 ml * (Dimetapp) wal-zyr 10 mg tablet 10 mg * (Zyrtec) wal-zyr d tablet 12 hr 5-120 mg * (Zyrtec-D) wal-phed pe sinus & allergy tb 4-10 wal-phed sinus and allergy tab 4-60 (Chlorpheniramine/ (Chlorpheniramine/ mg * mg * Phenylephrine) Pseudoephed) www.centersplan.com/fida/participants 58

wal-zyr solution children's, a/f 1 mg/ml * (Children'S Zyrtec) ZYRTEC 10 MG LIQUID GELS 10 MG * ZYRTEC 10 MG ODT 10 MG * ZYRTEC 10 MG TABLET INDOOR/OUTDOOR 24 HR (OTC) 10 MG * Anti-Infectives (Skin And Mucous Membrane) Anti-Infectives (Skin And Mucous Membrane) ABREVA 10% CREAM 10 % * AVC VAGINAL VAGINAL CREAM 15 % clindamycin phosphate vaginal cream 2 % (Cleocin) metronidazole vaginal gel 0.75 % (Metrogel-Vaginal) terconazole vaginal cream 0.4 %, 0.8 % (Terazol 7) terconazole vaginal suppository 80 mg (Terconazole) Antimigraine Agents Antimigraine Agents dihydroergotamine injection QL (30 per 28 days) (D.H.E.45) solution 1 mg/ml dihydroergotamine nasal spray,nonaerosol 0.5 mg/pump act. (4 mg/ml) QL (8 per 28 days) (Migranal) ERGOMAR SUBLINGUAL QL (40 per 28 days) TABLET 2 MG naratriptan oral tablet 1 mg, 2.5 mg (Amerge) QL (18 per 28 days) rizatriptan oral tablet 10 mg, 5 mg (Maxalt) QL (18 per 28 days) rizatriptan oral tablet,disintegrating QL (18 per 28 days) (Maxalt Mlt) 10 mg, 5 mg sumatriptan 6 mg/0.5 ml syrng (Sumatriptan QL (4 per 28 days) p/f,dehp/f,pvc/f 6 mg/0.5 ml Succinate) www.centersplan.com/fida/participants 59

sumatriptan nasal spray,nonaerosol 20 mg/actuation, 5 mg/actuation sumatriptan succinate oral tablet 100 mg, 25 mg, 50 mg sumatriptan succinate subcutaneous cartridge 4 mg/0.5 ml sumatriptan succinate subcutaneous cartridge 6 mg/0.5 ml sumatriptan succinate subcutaneous pen injector 4 mg/0.5 ml sumatriptan succinate subcutaneous pen injector 6 mg/0.5 ml, 6 mg/0.5 ml (auto-injector) sumatriptan succinate subcutaneous solution 6 mg/0.5 ml zolmitriptan oral tablet 2.5 mg, 5 mg zolmitriptan oral tablet,disintegrating 2.5 mg, 5 mg Antimycobacterials Antimycobacterials CAPASTAT INJECTION RECON SOLN 1 GRAM (Imitrex) (Imitrex) (Sumatriptan Succinate) (Imitrex) (Sumatriptan Succinate) (Sumatriptan Succinate) (Imitrex) (Zomig) (Zomig Zmt) dapsone oral tablet 100 mg, 25 mg (Dapsone) ethambutol oral tablet 100 mg, 400 mg (Myambutol) isoniazid oral solution 50 mg/5 ml (Isoniazid) isoniazid oral tablet 100 mg, 300 mg (Isoniazid) PASER ORAL GRANULES DR FOR SUSP IN PACKET 4 GRAM PRIFTIN ORAL TABLET 150 MG pyrazinamide oral tablet 500 mg (Pyrazinamide) rifabutin oral capsule 150 mg (Mycobutin) rifampin intravenous recon soln 600 mg (Rifadin) QL (12 per 28 days) QL (18 per 28 days) QL (4 per 28 days) QL (4 per 28 days) QL (4 per 28 days) QL (4 per 28 days) QL (4 per 28 days) QL (12 per 28 days) QL (12 per 28 days) www.centersplan.com/fida/participants 60

rifampin oral capsule 150 mg, 300 mg RIFATER ORAL TABLET 50-120- 300 MG SIRTURO ORAL TABLET 100 MG TRECATOR ORAL TABLET 250 MG Antinausea Agents Antinausea Agents AKYNZEO ORAL CAPSULE 300- (Rifadin) PA; QL (188 per 168 days) 0.5 MG compro rectal suppository 25 mg (Compazine) cvs motion sickness 50 mg tab 50 mg * (Dimenhydrinate) dimenhydrinate injection solution 50 (Dimenhydrinate) mg/ml dramamine 50 mg tablet 50 mg * (Dimenhydrinate) dramamine less drowsy 25 mg tb 25 mg * (Meclizine HCl) driminate 50 mg tablet 50 mg * (Dimenhydrinate) dronabinol oral capsule 10 mg, 2.5 mg, 5 mg (Marinol) EMEND INTRAVENOUS RECON QL (2 per 28 days) SOLN 115 MG, 150 MG EMEND ORAL CAPSULE 125 MG, 80 MG EMEND ORAL CAPSULE 40 MG EMEND ORAL CAPSULE,DOSE PACK 125 MG (1)- 80 MG (2) granisetron (pf) intravenous (Granisetron solution 100 mcg/ml HCl/PF) granisetron hcl intravenous solution 1 mg/ml (1 ml) (Granisetron HCl) granisetron hcl oral tablet 1 mg (Granisetron HCl) meclizine 12.5 mg caplet caplet (otc) 12.5 mg * (Meclizine HCl) meclizine 25 mg tablet (otc) 25 mg * (Meclizine HCl) www.centersplan.com/fida/participants 61

meclizine oral tablet 12.5 mg, 25 mg (Antivert) motion sickness 25 mg tablet 25 mg * (Meclizine HCl) ondansetron hcl (pf) injection (Ondansetron solution 4 mg/2 ml HCl/PF) ondansetron hcl (pf) injection (Ondansetron syringe 4 mg/2 ml HCl/PF) ondansetron hcl oral solution 4 mg/5 ml (Zofran) ondansetron hcl oral tablet 24 mg, 4 mg, 8 mg (Zofran) ondansetron oral tablet,disintegrating 4 mg, 8 mg (Zofran Odt) phenadoz rectal suppository 12.5 mg, 25 mg (Phenergan) prochlorperazine edisylate injection (Prochlorperazine solution 10 mg/2 ml (5 mg/ml) Edisylate) prochlorperazine maleate oral tablet 10 mg, 5 mg (Compazine) prochlorperazine rectal suppository 25 mg (Compazine) promethazine oral tablet 12.5 mg, (Promethazine 25 mg, 50 mg HCl) promethazine rectal suppository 12.5 mg, 25 mg, 50 mg (Phenergan) promethegan rectal suppository 12.5 mg, 25 mg, 50 mg (Phenergan) TRANSDERM-SCOP TRANSDERMAL PATCH 3 DAY 1.5 MG (1 MG OVER 3 DAYS) travel sickness 25 mg tab chew 25 mg * (Bonine) wal-dram 50 mg tablet 50 mg * (Dimenhydrinate) Antiparasite Agents Antiparasite Agents ALBENZA ORAL TABLET 200 MG PA-HRM PA-HRM PA-HRM PA-HRM QL (10 per 30 days) www.centersplan.com/fida/participants 62

ALINIA ORAL SUSPENSION FOR RECONSTITUTION 100 MG/5 ML ALINIA ORAL TABLET 500 MG atovaquone oral suspension 750 mg/5 ml (Mepron) atovaquone-proguanil oral tablet 250-100 mg, 62.5-25 mg (Malarone) chloroquine phosphate oral tablet (Chloroquine 250 mg, 500 mg Phosphate) COARTEM ORAL TABLET 20-120 MG DARAPRIM ORAL TABLET 25 MG EMVERM ORAL TABLET,CHEWABLE 100 MG hydroxychloroquine oral tablet 200 (Plaquenil) mg ivermectin oral tablet 3 mg (Stromectol) mefloquine oral tablet 250 mg (Mefloquine HCl) NEBUPENT INHALATION RECON SOLN 300 MG paromomycin oral capsule 250 mg PENTAM INJECTION RECON SOLN 300 MG PRIMAQUINE ORAL TABLET 26.3 MG (Paromomycin Sulfate) QL (6 per 21 days) QL (90 per 30 days) quinine sulfate oral capsule 324 mg (Qualaquin) PA; QL (42 per 7 days) Antiparkinsonian Agents Antiparkinsonian Agents amantadine hcl oral capsule 100 mg (Amantadine HCl) amantadine hcl oral solution 50 mg/5 ml (Amantadine HCl) amantadine hcl oral tablet 100 mg (Amantadine HCl) APOKYN SUBCUTANEOUS CARTRIDGE 10 MG/ML QL (60 per 30 days) www.centersplan.com/fida/participants 63

AZILECT ORAL TABLET 0.5 MG, 1 MG benztropine oral tablet 0.5 mg, 1 (Benztropine mg, 2 mg Mesylate) bromocriptine oral capsule 5 mg (Parlodel) bromocriptine oral tablet 2.5 mg (Parlodel) cabergoline oral tablet 0.5 mg (Cabergoline) carbidopa oral tablet 25 mg (Lodosyn) carbidopa-levodopa oral tablet 10-100 mg, 25-100 mg, 25-250 mg (Sinemet CR) carbidopa-levodopa oral tablet extended release 25-100 mg, 50-200 (Sinemet CR) mg carbidopa-levodopa-entacapone oral tablet 12.5-50-200 mg, 18.75-75-200 mg, 25-100-200 mg, 31.25- (Stalevo 50) 125-200 mg, 37.5-150-200 mg, 50-200-200 mg entacapone oral tablet 200 mg (Comtan) NEUPRO TRANSDERMAL PATCH 24 HOUR 1 MG/24 HOUR, 2 MG/24 HOUR, 3 MG/24 HOUR, 4 MG/24 HOUR, 6 MG/24 HOUR, 8 MG/24 HOUR pramipexole oral tablet 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 (Mirapex) mg ropinirole oral tablet 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg (Requip) ropinirole oral tablet extended release 24 hr 12 mg, 2 mg, 4 mg, 6 (Requip XL) mg, 8 mg selegiline hcl oral capsule 5 mg (Eldepryl) selegiline hcl oral tablet 5 mg (Selegiline HCl) trihexyphenidyl oral elixir 0.4 mg/ml (Trihexyphenidyl HCl) trihexyphenidyl oral tablet 2 mg, 5 mg (Trihexyphenidyl HCl) PA-HRM PA-HRM PA-HRM www.centersplan.com/fida/participants 64

Antipsychotic Agents Antipsychotic Agents ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 300 MG ABILIFY MAINTENA INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 400 MG QL (1 per 28 days) ABILIFY MAINTENA QL (1 per 28 days) INTRAMUSCULAR SUSPENSION,EXTENDED REL SYRING 300 MG, 400 MG aripiprazole oral solution 1 mg/ml (Abilify) QL (900 per 30 days) aripiprazole oral tablet 10 mg, 15 QL (30 per 30 days) (Abilify) mg, 20 mg, 30 mg, 5 mg aripiprazole oral tablet 2 mg (Abilify) QL (60 per 30 days) aripiprazole oral QL (90 per 30 days) (Abilify Discmelt) tablet,disintegrating 10 mg aripiprazole oral QL (60 per 30 days) (Abilify Discmelt) tablet,disintegrating 15 mg ARISTADA INTRAMUSCULAR QL (1.6 per 28 days) SUSPENSION,EXTENDED REL SYRING 441 MG/1.6 ML ARISTADA INTRAMUSCULAR QL (2.4 per 28 days) SUSPENSION,EXTENDED REL SYRING 662 MG/2.4 ML ARISTADA INTRAMUSCULAR QL (3.2 per 28 days) SUSPENSION,EXTENDED REL SYRING 882 MG/3.2 ML chlorpromazine injection solution (Chlorpromazine 25 mg/ml HCl) chlorpromazine oral tablet 10 mg, (Chlorpromazine 100 mg, 200 mg, 25 mg, 50 mg HCl) clozapine oral tablet 100 mg (Clozaril) QL (270 per 30 days) clozapine oral tablet 200 mg (Clozaril) QL (135 per 30 days) clozapine oral tablet 25 mg, 50 mg (Clozaril) QL (90 per 30 days) www.centersplan.com/fida/participants 65

clozapine oral tablet,disintegrating 100 mg, 12.5 mg, 150 mg, 200 mg, 25 mg FANAPT ORAL TABLET 1 MG, 10 MG, 12 MG, 2 MG, 4 MG, 6 MG, 8 MG FANAPT ORAL TABLETS,DOSE PACK 1MG(2)-2MG(2)- 4MG(2)- 6MG(2) fluphenazine decanoate injection solution 25 mg/ml fluphenazine hcl injection solution 2.5 mg/ml fluphenazine hcl oral concentrate 5 mg/ml fluphenazine hcl oral elixir 2.5 mg/5 ml fluphenazine hcl oral tablet 1 mg, 10 mg, 2.5 mg, 5 mg GEODON INTRAMUSCULAR RECON SOLN 20 MG/ML (FINAL CONC.) haloperidol decanoate intramuscular solution 100 mg/ml haloperidol decanoate intramuscular solution 50 mg/ml haloperidol lactate injection solution 5 mg/ml haloperidol lactate oral concentrate 2 mg/ml haloperidol oral tablet 0.5 mg, 1 mg, 10 mg, 2 mg, 20 mg, 5 mg INVEGA SUSTENNA INTRAMUSCULAR SYRINGE 117 MG/0.75 ML, 156 MG/ML, 234 MG/1.5 ML, 39 MG/0.25 ML, 78 MG/0.5 ML (Fazaclo) (Fluphenazine Decanoate) (Fluphenazine HCl) (Fluphenazine HCl) (Fluphenazine HCl) (Fluphenazine HCl) (Haloperidol Decanoate) (Haldol Decanoate 50) (Haloperidol Lactate) (Haloperidol Lactate) (Haloperidol) ST ST; QL (60 per 30 days) ST; QL (8 per 28 days) QL (6 per 28 days) www.centersplan.com/fida/participants 66

INVEGA TRINZA INTRAMUSCULAR SYRINGE 273 MG/0.875 ML, 410 MG/1.315 ML, 546 MG/1.75 ML, 819 MG/2.625 ML LATUDA ORAL TABLET 120 MG, 20 MG, 40 MG, 60 MG, 80 MG loxapine succinate oral capsule 10 (Loxapine mg, 25 mg, 5 mg, 50 mg Succinate) molindone oral tablet 10 mg (Moban) QL (240 per 30 days) molindone oral tablet 25 mg (Moban) QL (270 per 30 days) molindone oral tablet 5 mg (Moban) QL (120 per 30 days) NUPLAZID ORAL TABLET 17 PA NSO; QL (60 per MG 30 days) olanzapine intramuscular recon soln QL (30 per 30 days) (Zyprexa) 10 mg olanzapine oral tablet 10 mg, 15 QL (30 per 30 days) (Zyprexa) mg, 2.5 mg, 20 mg, 5 mg, 7.5 mg olanzapine oral tablet,disintegrating QL (30 per 30 days) (Zyprexa Zydis) 10 mg, 15 mg, 5 mg olanzapine oral tablet,disintegrating QL (31 per 30 days) (Zyprexa Zydis) 20 mg paliperidone oral tablet extended QL (30 per 30 days) (Invega) release 24hr 1.5 mg, 3 mg, 9 mg paliperidone oral tablet extended QL (60 per 30 days) (Invega) release 24hr 6 mg perphenazine oral tablet 16 mg, 2 mg, 4 mg, 8 mg (Perphenazine) pimozide oral tablet 1 mg, 2 mg (Orap) quetiapine oral tablet 100 mg, 200 QL (90 per 30 days) (Seroquel) mg, 25 mg, 300 mg, 400 mg, 50 mg REXULTI ORAL TABLET 0.25 QL (120 per 30 days) MG REXULTI ORAL TABLET 0.5 MG QL (60 per 30 days) REXULTI ORAL TABLET 1 MG, QL (30 per 30 days) 2 MG, 3 MG, 4 MG www.centersplan.com/fida/participants 67

RISPERDAL CONSTA QL (4 per 28 days) INTRAMUSCULAR SYRINGE 12.5 MG/2 ML, 25 MG/2 ML, 37.5 MG/2 ML, 50 MG/2 ML risperidone oral solution 1 mg/ml (Risperdal) QL (480 per 30 days) risperidone oral tablet 0.25 mg, 0.5 QL (60 per 30 days) (Risperdal) mg, 1 mg, 2 mg, 3 mg, 4 mg risperidone oral QL (60 per 30 days) tablet,disintegrating 0.25 mg, 0.5 mg, 1 mg, 2 mg (Risperdal M-Tab) risperidone oral (Risperdal M-Tab) QL (120 per 30 days) tablet,disintegrating 3 mg, 4 mg SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET 10 MG, 2.5 MG, 5 MG thioridazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg thiothixene oral capsule 1 mg, 10 mg, 2 mg, 5 mg trifluoperazine oral tablet 1 mg, 10 mg, 2 mg, 5 mg VERSACLOZ ORAL SUSPENSION 50 MG/ML VRAYLAR ORAL CAPSULE 1.5 MG, 3 MG, 4.5 MG, 6 MG VRAYLAR ORAL CAPSULE,DOSE PACK 1.5 MG (1)- 3 MG (6) ziprasidone hcl oral capsule 20 mg, 40 mg, 60 mg, 80 mg ZYPREXA RELPREVV 405 MG VL KIT W/ DILUENT, OUTER 405 MG ZYPREXA RELPREVV INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 210 MG Antivirals (Systemic) (Thioridazine HCl) (Thiothixene) (Trifluoperazine HCl) (Geodon) ST; QL (60 per 30 days) PA NSO-HRM ST; QL (540 per 30 days) QL (30 per 30 days) QL (7 per 30 days) QL (60 per 30 days) www.centersplan.com/fida/participants 68

Antiretrovirals abacavir oral tablet 300 mg (Ziagen) abacavir-lamivudine-zidovudine oral tablet 300-150-300 mg (Trizivir) APTIVUS ORAL CAPSULE 250 MG APTIVUS ORAL SOLUTION 100 MG/ML ATRIPLA ORAL TABLET 600-200-300 MG COMPLERA ORAL TABLET 200-25-300 MG CRIXIVAN ORAL CAPSULE 200 MG, 400 MG DESCOVY ORAL TABLET 200-25 MG didanosine oral capsule,delayed release(dr/ec) 125 mg, 200 mg, 250 (Videx EC) mg, 400 mg EDURANT ORAL TABLET 25 MG EMTRIVA ORAL CAPSULE 200 MG EMTRIVA ORAL SOLUTION 10 MG/ML EPIVIR HBV ORAL SOLUTION 25 MG/5 ML (5 MG/ML) EPZICOM ORAL TABLET 600-300 MG EVOTAZ ORAL TABLET 300-150 MG FUZEON SUBCUTANEOUS RECON SOLN 90 MG GENVOYA ORAL TABLET 150-150-200-10 MG INTELENCE ORAL TABLET 100 MG, 200 MG, 25 MG www.centersplan.com/fida/participants 69

INVIRASE ORAL CAPSULE 200 MG INVIRASE ORAL TABLET 500 MG ISENTRESS ORAL POWDER IN PACKET 100 MG ISENTRESS ORAL TABLET 400 MG ISENTRESS ORAL TABLET,CHEWABLE 100 MG, 25 MG KALETRA ORAL SOLUTION 400-100 MG/5 ML KALETRA ORAL TABLET 100-25 MG, 200-50 MG lamivudine oral solution 10 mg/ml (Epivir) lamivudine oral tablet 100 mg, 150 mg, 300 mg (Epivir) lamivudine-zidovudine oral tablet 150-300 mg (Combivir) LEXIVA ORAL SUSPENSION 50 MG/ML LEXIVA ORAL TABLET 700 MG nevirapine oral suspension 50 mg/5 ml (Viramune) nevirapine oral tablet 200 mg (Viramune) nevirapine oral tablet extended release 24 hr 100 mg, 400 mg (Viramune XR) NORVIR ORAL CAPSULE 100 MG NORVIR ORAL SOLUTION 80 MG/ML NORVIR ORAL TABLET 100 MG ODEFSEY ORAL TABLET 200-25-25 MG PREZCOBIX ORAL TABLET 800-150 MG-MG www.centersplan.com/fida/participants 70

PREZISTA ORAL SUSPENSION 100 MG/ML PREZISTA ORAL TABLET 150 MG, 400 MG, 600 MG, 75 MG, 800 MG RESCRIPTOR ORAL TABLET 200 MG RESCRIPTOR ORAL TABLET, DISPERSIBLE 100 MG RETROVIR INTRAVENOUS SOLUTION 10 MG/ML REYATAZ ORAL CAPSULE 150 MG, 200 MG, 300 MG REYATAZ ORAL POWDER IN PACKET 50 MG SELZENTRY ORAL TABLET 150 MG, 300 MG stavudine oral capsule 15 mg, 20 mg, 30 mg, 40 mg (Zerit) stavudine oral recon soln 1 mg/ml (Zerit) STRIBILD ORAL TABLET 150-150-200-300 MG SUSTIVA ORAL CAPSULE 200 MG, 50 MG SUSTIVA ORAL TABLET 600 MG TIVICAY ORAL TABLET 50 MG TRIUMEQ ORAL TABLET 600-50-300 MG TRUVADA ORAL TABLET 100-150 MG, 133-200 MG, 167-250 MG, 200-300 MG VIDEX 2 GRAM PEDIATRIC ORAL RECON SOLN 10 MG/ML (FINAL) VIDEX 4 GM PEDIATRIC SOLN 10 MG/ML (FINAL) www.centersplan.com/fida/participants 71

VIRACEPT ORAL TABLET 250 MG, 625 MG VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HR 100 MG VIREAD ORAL POWDER 40 MG/SCOOP (40 MG/GRAM) VIREAD ORAL TABLET 150 MG, 200 MG, 250 MG, 300 MG VITEKTA ORAL TABLET 150 MG, 85 MG ZIAGEN ORAL SOLUTION 20 MG/ML zidovudine oral capsule 100 mg (Retrovir) zidovudine oral syrup 10 mg/ml (Retrovir) zidovudine oral tablet 300 mg (Zidovudine) Antivirals, Miscellaneous foscarnet intravenous solution 24 mg/ml (Foscavir) RELENZA DISKHALER INHALATION BLISTER WITH DEVICE 5 MG/ACTUATION rimantadine oral tablet 100 mg (Flumadine) SYNAGIS 100 MG/1 ML VIAL 100 MG/ML SYNAGIS INTRAMUSCULAR SOLUTION 50 MG/0.5 ML TAMIFLU ORAL CAPSULE 30 MG TAMIFLU ORAL CAPSULE 45 MG TAMIFLU ORAL CAPSULE 75 MG TAMIFLU ORAL SUSPENSION FOR RECONSTITUTION 6 MG/ML Hcv Antivirals QL (84 per 180 days) QL (48 per 180 days) QL (42 per 180 days) QL (540 per 180 days) www.centersplan.com/fida/participants 72

DAKLINZA ORAL TABLET 30 MG, 60 MG, 90 MG HARVONI ORAL TABLET 90-400 MG OLYSIO ORAL CAPSULE 150 MG SOVALDI ORAL TABLET 400 MG TECHNIVIE ORAL TABLET 12.5-75-50 MG VIEKIRA PAK ORAL TABLETS,DOSE PACK 12.5 MG- 75 MG -50 MG/250 MG ZEPATIER ORAL TABLET 50-100 MG Interferons INTRON A 25 MILLION UNIT/2.5 ML 10 MILLION UNIT/ML INTRON A INJECTION RECON SOLN 10 MILLION UNIT (1 ML) INTRON A INJECTION RECON SOLN 18 MILLION UNIT (1 ML), 50 MILLION UNIT (1 ML) INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML PEGASYS PROCLICK SUBCUTANEOUS PEN INJECTOR 135 MCG/0.5 ML, 180 MCG/0.5 ML PEGASYS SUBCUTANEOUS SOLUTION 180 MCG/ML PEGASYS SUBCUTANEOUS SYRINGE 180 MCG/0.5 ML PEGINTRON SUBCUTANEOUS KIT 120 MCG/0.5 ML, 150 MCG/0.5 ML, 50 MCG/0.5 ML, 80 MCG/0.5 ML PA; QL (28 per 28 days) PA; QL (30 per 30 days) PA; QL (28 per 28 days) PA; QL (28 per 28 days) PA; QL (56 per 28 days) PA; QL (112 per 28 days) PA; QL (30 per 30 days) PA NSO PA NSO PA NSO PA NSO PA PA PA PA www.centersplan.com/fida/participants 73

SYLATRON SUBCUTANEOUS KIT 200 MCG, 300 MCG, 600 MCG Nucleosides And Nucleotides acyclovir oral capsule 200 mg (Zovirax) acyclovir oral suspension 200 mg/5 ml (Zovirax) acyclovir oral tablet 400 mg, 800 mg (Zovirax) acyclovir sodium intravenous (Acyclovir solution 50 mg/ml Sodium) adefovir oral tablet 10 mg (Hepsera) entecavir oral tablet 0.5 mg, 1 mg (Baraclude) famciclovir oral tablet 125 mg, 250 mg, 500 mg (Famvir) ganciclovir sodium intravenous recon soln 500 mg (Cytovene) ribasphere oral capsule 200 mg (Rebetol) ribasphere oral tablet 200 mg, 400 mg, 600 mg (Copegus) TYZEKA ORAL TABLET 600 MG valacyclovir oral tablet 1 gram, 500 mg (Valtrex) valganciclovir oral tablet 450 mg (Valcyte) VIRAZOLE INHALATION RECON SOLN 6 GRAM Blood Products/Modifiers/Volume Expanders Anticoagulants CEPROTIN (BLUE BAR) INTRAVENOUS RECON SOLN 500 UNIT ELIQUIS ORAL TABLET 2.5 MG, 5 MG enoxaparin subcutaneous solution 300 mg/3 ml (Lovenox) PA NSO; QL (4 per 28 days) www.centersplan.com/fida/participants 74

enoxaparin subcutaneous syringe 100 mg/ml, 120 mg/0.8 ml, 150 mg/ml, 30 mg/0.3 ml, 40 mg/0.4 ml, 60 mg/0.6 ml, 80 mg/0.8 ml fondaparinux subcutaneous syringe 10 mg/0.8 ml fondaparinux subcutaneous syringe 2.5 mg/0.5 ml fondaparinux subcutaneous syringe 5 mg/0.4 ml fondaparinux subcutaneous syringe 7.5 mg/0.6 ml heparin (porcine) in 5 % dex intravenous parenteral solution 12,500 unit/250 ml, 20,000 unit/500 ml (40 unit/ml), 25,000 unit/500 ml (50 unit/ml) heparin (porcine) in 5 % dex intravenous parenteral solution 25,000 unit/250 ml(100 unit/ml) heparin (porcine) in nacl (pf) intravenous parenteral solution 1,000 unit/500 ml heparin (porcine) injection solution 1,000 unit/ml, 10,000 unit/ml, 20,000 unit/ml, 5,000 unit/ml heparin, porcine (pf) injection solution 5,000 unit/0.5 ml heparin, porcine (pf) injection syringe 5,000 unit/0.5 ml heparin-0.45% nacl 25,000 units/250 ml (100 units/ml) bag latex-free, inner 25,000 unit/250 ml heparin-d5w 25,000 units/250 ml (100 units/ml) bag excel container 25,000 unit/250 ml(100 unit/ml) IPRIVASK SUBCUTANEOUS RECON SOLN 15 MG (Lovenox) (Arixtra) (Arixtra) (Arixtra) (Arixtra) (Heparin Sodium,Porcine/D5 W) (Heparin Sod,Pork In 0.45% NaCl) (Heparin Sodium,Porcine/Ns /PF) (Heparin Sodium,Porcine) (Heparin Sodium,Porcine/PF ) (Monoject Prefill Advanced) (Heparin Sod,Pork In 0.45% NaCl) (Heparin Sodium,Porcine/D5 W) QL (24 per 30 days) QL (15 per 30 days) QL (12 per 30 days) QL (18 per 30 days) PA; QL (24 per 28 days) www.centersplan.com/fida/participants 75

jantoven oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg PRADAXA ORAL CAPSULE 110 MG, 150 MG, 75 MG warfarin oral tablet 1 mg, 10 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg XARELTO ORAL TABLET 10 MG, 15 MG, 20 MG XARELTO ORAL TABLETS,DOSE PACK 15 MG (42)- 20 MG (9) Blood Formation Modifiers CINRYZE INTRAVENOUS RECON SOLN 500 UNIT (5 ML) EPOGEN 10,000 UNITS/ML VIAL SDV, P/F, OUTER 10,000 UNIT/ML EPOGEN INJECTION SOLUTION 2,000 UNIT/ML, 20,000 UNIT/2 ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML GRANIX SUBCUTANEOUS SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML LEUKINE INJECTION RECON SOLN 250 MCG MIRCERA INJECTION SYRINGE 100 MCG/0.3 ML, 200 MCG/0.3 ML, 50 MCG/0.3 ML, 75 MCG/0.3 ML MOZOBIL SUBCUTANEOUS SOLUTION 24 MG/1.2 ML (20 MG/ML) NEULASTA SUBCUTANEOUS SYRINGE 6 MG/0.6ML (Coumadin) (Coumadin) ST; QL (60 per 30 days) PA PA; QL (12 per 28 days) PA; QL (12 per 28 days) PA; QL (0.6 per 28 days) www.centersplan.com/fida/participants 76

NEULASTA SUBCUTANEOUS SYRINGE, W/ WEARABLE INJECTOR 6 MG/0.6 ML NEUMEGA SUBCUTANEOUS RECON SOLN 5 MG NEUPOGEN INJECTION SOLUTION 300 MCG/ML, 480 MCG/1.6 ML NEUPOGEN INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML PROCRIT 10,000 UNITS/ML VIAL 4'S, MDV, OUTER 20,000 UNIT/2 ML PROCRIT INJECTION SOLUTION 10,000 UNIT/ML, 2,000 UNIT/ML, 20,000 UNIT/ML, 3,000 UNIT/ML, 4,000 UNIT/ML PROCRIT INJECTION SOLUTION 40,000 UNIT/ML PROMACTA ORAL TABLET 12.5 MG, 25 MG, 50 MG, 75 MG ZARXIO INJECTION SYRINGE 300 MCG/0.5 ML, 480 MCG/0.8 ML Hematologic Agents, Miscellaneous aminocaproic acid oral solution 250 mg/ml (25 %) aminocaproic acid oral tablet 1,000 mg, 500 mg anagrelide oral capsule 0.5 mg, 1 mg protamine intravenous solution 10 mg/ml tranexamic acid intravenous solution 1,000 mg/10 ml (100 mg/ml) (Aminocaproic Acid) (Aminocaproic Acid) (Agrylin) (Protamine Sulfate) (Tranexamic Acid) PA; QL (12 per 28 days) PA; QL (12 per 28 days) PA; QL (6 per 28 days) PA; QL (30 per 30 days) tranexamic acid oral tablet 650 mg (Lysteda) QL (30 per 30 days) www.centersplan.com/fida/participants 77

Platelet-Aggregation Inhibitors aspirin-dipyridamole oral capsule, er multiphase 12 hr 25-200 mg (Aggrenox) BRILINTA ORAL TABLET 60 MG, 90 MG cilostazol oral tablet 100 mg, 50 mg (Pletal) clopidogrel oral tablet 300 mg, 75 mg (Plavix) dipyridamole oral tablet 25 mg, 50 mg, 75 mg (Persantine) EFFIENT ORAL TABLET 10 MG, 5 MG pentoxifylline oral tablet extended release 400 mg (Pentoxifylline) Caloric Agents Caloric Agents AMINO ACIDS 15 % INTRAVENOUS PARENTERAL SOLUTION 15 % AMINOSYN 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % AMINOSYN 3.5 % INTRAVENOUS PARENTERAL SOLUTION 3.5 % AMINOSYN 7 % INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN 7 % WITH ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN 8.5 % INTRAVENOUS PARENTERAL SOLUTION 8.5 % QL (30 per 30 days) www.centersplan.com/fida/participants 78

AMINOSYN 8.5 %- ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 8.5 % AMINOSYN II 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % AMINOSYN II 15 % INTRAVENOUS PARENTERAL SOLUTION 15 % AMINOSYN II 7 % INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN II 8.5 % INTRAVENOUS PARENTERAL SOLUTION 8.5 % AMINOSYN II 8.5 %- ELECTROLYTES INTRAVENOUS PARENTERAL SOLUTION 8.5 % AMINOSYN M 3.5 % INTRAVENOUS PARENTERAL SOLUTION 3.5 % AMINOSYN-HBC 7% INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN-PF 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % AMINOSYN-PF 7 % (SULFITE- FREE) INTRAVENOUS PARENTERAL SOLUTION 7 % AMINOSYN-RF 5.2 % INTRAVENOUS PARENTERAL SOLUTION 5.2 % CLINIMIX 5%/D15W SULFITE FREE INTRAVENOUS PARENTERAL SOLUTION 5 % www.centersplan.com/fida/participants 79

CLINIMIX 5%/D25W SULFITE- FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX 2.75%/D5W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 2.75 % CLINIMIX 4.25%/D10W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX 4.25%/D5W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX 4.25%-D20W SULF- FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX 4.25%-D25W SULF- FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX 5%-D20W(SULFITE- FREE) INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX E 2.75%/D10W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 2.75 % CLINIMIX E 2.75%/D5W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 2.75 % CLINIMIX E 4.25%/D10W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % www.centersplan.com/fida/participants 80

CLINIMIX E 4.25%/D25W SUL FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX E 4.25%/D5W SULF FREE INTRAVENOUS PARENTERAL SOLUTION 4.25 % CLINIMIX E 5%/D15W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX E 5%/D20W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINIMIX E 5%/D25W SULFIT FREE INTRAVENOUS PARENTERAL SOLUTION 5 % CLINISOL SF 15 % INTRAVENOUS PARENTERAL SOLUTION 15 % cysteine (l-cysteine) intravenous solution 50 mg/ml dex4 glucose 4 gm tablet chew grape flavor 4 gram * dextrose 10 % in water (d10w) intravenous parenteral solution 10 % dextrose 20 % in water (d20w) intravenous parenteral solution 20 % dextrose 25 % in water (d25w) intravenous syringe dextrose 40 % in water (d40w) intravenous parenteral solution 40 % dextrose 5 % in ringers intravenous parenteral solution 5 % dextrose 5 % in water (d5w) intravenous parenteral solution (Cysteine HCl) (Dextrose) (Dextrose 10 % in Water) (Dextrose 20 % in Water) (Dextrose 25 % in Water) (Dextrose 40 % in Water) (Dextrose 5 % In Ringers) (Dextrose 5 % in Water) www.centersplan.com/fida/participants 81

dextrose 50 % in water (d50w) (Dextrose 50 % in intravenous parenteral solution Water) dextrose 50 % in water (d50w) (Dextrose 50 % in intravenous syringe Water) dextrose 70 % in water (d70w) (Dextrose 70 % in intravenous parenteral solution Water) FREAMINE HBC 6.9 % INTRAVENOUS PARENTERAL SOLUTION 6.9 % FREAMINE III 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % gluco burst 40% gel 40 % * (Dextrose) glucose 4 gram tablet chew na/f, (Dextrose) caffeine free 4 gram * glucose 40% gel tropical fruit 40 % * glutose 15 gel 3 pak, outer, u-d 40 (Dextrose) % * HEPATAMINE 8% INTRAVENOUS PARENTERAL SOLUTION 8 % HEPATASOL 8 % INTRAVENOUS PARENTERAL SOLUTION 8 % insta-glucose gel 24 gram/31 gram (Dextrose/Dextrin/ * Maltose) INTRALIPID INTRAVENOUS EMULSION 20 %, 30 % KABIVEN INTRAVENOUS EMULSION 3.31-9.8-3.9 % LIPOSYN II INTRAVENOUS EMULSION 20 % LIPOSYN III INTRAVENOUS EMULSION 10 %, 20 %, 30 % NEPHRAMINE 5.4 % INTRAVENOUS PARENTERAL SOLUTION 5.4 % www.centersplan.com/fida/participants 82

NUTRILIPID INTRAVENOUS EMULSION 20 % PERIKABIVEN INTRAVENOUS EMULSION 2.36-6.8-3.5 % PREMASOL 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % PREMASOL 6 % INTRAVENOUS PARENTERAL SOLUTION 6 % PROCALAMINE 3% INTRAVENOUS PARENTERAL SOLUTION 3 % PROSOL 20 % INTRAVENOUS PARENTERAL SOLUTION TRAVASOL 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % TROPHAMINE 10 % INTRAVENOUS PARENTERAL SOLUTION 10 % TROPHAMINE 6% INTRAVENOUS PARENTERAL SOLUTION 6 % Cardiovascular Agents Alpha-Adrenergic Agents clonidine hcl oral tablet 0.1 mg, 0.2 mg, 0.3 mg clonidine transdermal patch weekly 0.1 mg/24 hr, 0.2 mg/24 hr clonidine transdermal patch weekly 0.3 mg/24 hr clorpres oral tablet 0.1-15 mg, 0.2-15 mg, 0.3-15 mg (Catapres) (Catapres-Tts 1) (Catapres-Tts 1) (Clonidine HCl/Chlorthalidon e) QL (4 per 28 days) QL (8 per 28 days) doxazosin oral tablet 1 mg, 2 mg, 4 mg, 8 mg (Cardura) guanfacine oral tablet 1 mg, 2 mg (Tenex) PA-HRM www.centersplan.com/fida/participants 83

midodrine oral tablet 10 mg, 2.5 mg, 5 mg NORTHERA ORAL CAPSULE 100 MG, 200 MG, 300 MG phenylephrine hcl injection solution 10 mg/ml prazosin oral capsule 1 mg, 2 mg, 5 mg Angiotensin Ii Receptor Antagonists BENICAR HCT ORAL TABLET 20-12.5 MG, 40-12.5 MG, 40-25 MG BENICAR ORAL TABLET 20 MG, 40 MG, 5 MG candesartan oral tablet 16 mg, 32 mg, 4 mg, 8 mg candesartan-hydrochlorothiazid oral tablet 16-12.5 mg, 32-12.5 mg, 32-25 mg ENTRESTO ORAL TABLET 24-26 MG, 49-51 MG, 97-103 MG irbesartan oral tablet 150 mg, 300 mg, 75 mg irbesartan-hydrochlorothiazide oral tablet 150-12.5 mg, 300-12.5 mg losartan oral tablet 100 mg, 25 mg, 50 mg losartan-hydrochlorothiazide oral tablet 100-12.5 mg, 100-25 mg, 50-12.5 mg telmisartan oral tablet 20 mg, 40 mg, 80 mg telmisartan-hydrochlorothiazid oral tablet 40-12.5 mg, 80-12.5 mg, 80-25 mg (Midodrine HCl) (Vazculep) (Minipress) (Atacand) (Atacand HCT) (Avapro) (Avalide) (Cozaar) (Hyzaar) (Micardis) (Micardis HCT) PA; QL (180 per 30 days) PA; QL (60 per 30 days) www.centersplan.com/fida/participants 84

TRIBENZOR ORAL TABLET 20-5-12.5 MG, 40-10-12.5 MG, 40-10- 25 MG, 40-5-12.5 MG, 40-5-25 MG valsartan oral tablet 160 mg, 320 mg, 40 mg, 80 mg valsartan-hydrochlorothiazide oral tablet 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg, 80-12.5 mg Angiotensin-Converting Enzyme Inhibitors benazepril oral tablet 10 mg, 20 mg, 40 mg, 5 mg benazepril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg, 5-6.25 mg captopril oral tablet 100 mg, 12.5 mg, 25 mg, 50 mg captopril-hydrochlorothiazide oral tablet 25-15 mg, 25-25 mg, 50-15 mg, 50-25 mg enalapril maleate oral tablet 10 mg, 2.5 mg, 20 mg, 5 mg enalaprilat intravenous solution 1.25 mg/ml enalapril-hydrochlorothiazide oral tablet 10-25 mg, 5-12.5 mg fosinopril oral tablet 10 mg, 20 mg, 40 mg fosinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg lisinopril oral tablet 10 mg, 2.5 mg, 20 mg, 30 mg, 40 mg, 5 mg lisinopril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg (Diovan) (Diovan HCT) (Lotensin) (Lotensin HCT) (Captopril) (Captopril/Hydroch lorothiazide) (Vasotec) (Enalaprilat Dihydrate) (Vaseretic) (Fosinopril Sodium) (Fosinopril/Hydroc hlorothiazide) (Zestril) (Zestoretic) moexipril oral tablet 15 mg, 7.5 mg (Moexipril HCl) ST www.centersplan.com/fida/participants 85

moexipril-hydrochlorothiazide oral tablet 15-12.5 mg, 15-25 mg, 7.5-12.5 mg perindopril erbumine oral tablet 2 mg, 4 mg, 8 mg quinapril oral tablet 10 mg, 20 mg, 40 mg, 5 mg quinapril-hydrochlorothiazide oral tablet 10-12.5 mg, 20-12.5 mg, 20-25 mg ramipril oral capsule 1.25 mg, 10 mg, 2.5 mg, 5 mg trandolapril oral tablet 1 mg, 2 mg, 4 mg Antiarrhythmic Agents amiodarone oral tablet 100 mg, 200 mg, 400 mg disopyramide phosphate oral capsule 100 mg, 150 mg flecainide oral tablet 100 mg, 150 mg, 50 mg lidocaine (pf) intravenous syringe 50 mg/5 ml (1 %) lidocaine in 5 % dextrose (pf) intravenous parenteral solution 8 mg/ml (0.8 %) mexiletine oral capsule 150 mg, 200 mg, 250 mg MULTAQ ORAL TABLET 400 MG pacerone oral tablet 100 mg, 200 mg, 400 mg procainamide injection solution 100 mg/ml, 500 mg/ml propafenone oral capsule,extended release 12 hr 225 mg, 325 mg, 425 mg (Moexipril/Hydroc hlorothiazide) (Aceon) (Accupril) (Accuretic) (Altace) (Mavik) (Cordarone) (Norpace) (Tambocor) (Lidocaine HCl/PF) (Lidocaine HCl/D5w/PF) (Mexiletine HCl) (Cordarone) (Procainamide HCl) (Rythmol SR) www.centersplan.com/fida/participants 86

propafenone oral tablet 150 mg, 225 (Rythmol) mg, 300 mg quinidine gluconate oral tablet (Quinidine extended release 324 mg Gluconate) quinidine sulfate oral tablet 200 mg, 300 mg (Quinidine Sulfate) quinidine sulfate oral tablet extended release 300 mg (Quinidine Sulfate) TIKOSYN ORAL CAPSULE 125 MCG, 250 MCG, 500 MCG Beta-Adrenergic Blocking Agents acebutolol oral capsule 200 mg, 400 mg (Sectral) atenolol oral tablet 100 mg, 25 mg, 50 mg (Tenormin) atenolol-chlorthalidone oral tablet 100-25 mg, 50-25 mg (Tenoretic 50) betaxolol oral tablet 10 mg, 20 mg (Kerlone) bisoprolol fumarate oral tablet 10 mg, 5 mg (Zebeta) bisoprolol-hydrochlorothiazide oral tablet 10-6.25 mg, 2.5-6.25 mg, 5- (Ziac) 6.25 mg BYSTOLIC ORAL TABLET 10 MG, 2.5 MG, 20 MG, 5 MG carvedilol oral tablet 12.5 mg, 25 mg, 3.125 mg, 6.25 mg (Coreg) esmolol intravenous solution 100 mg/10 ml (10 mg/ml) (Brevibloc) labetalol intravenous solution 5 mg/ml (Labetalol HCl) labetalol oral tablet 100 mg, 200 mg, 300 mg (Trandate) metoprolol succinate oral tablet extended release 24 hr 100 mg, 200 (Toprol XL) mg, 25 mg, 50 mg www.centersplan.com/fida/participants 87

metoprolol ta-hydrochlorothiaz oral tablet 100-25 mg, 100-50 mg, 50-25 (Lopressor HCT) mg metoprolol tartrate intravenous solution 5 mg/5 ml (Lopressor) metoprolol tartrate oral tablet 100 mg, 25 mg, 37.5 mg, 50 mg, 75 mg (Lopressor) nadolol oral tablet 20 mg, 40 mg, 80 (Corgard) mg pindolol oral tablet 10 mg, 5 mg (Pindolol) propranolol intravenous solution 1 mg/ml (Propranolol HCl) propranolol oral capsule,extended release 24 hr 120 mg, 160 mg, 60 (Inderal LA) mg, 80 mg propranolol oral solution 20 mg/5 ml (4 mg/ml), 40 mg/5 ml (8 mg/ml) (Propranolol HCl) propranolol oral tablet 10 mg, 20 mg, 40 mg, 60 mg, 80 mg (Propranolol HCl) propranolol-hydrochlorothiazid (Propranolol/Hydro oral tablet 40-25 mg, 80-25 mg chlorothiazid) sorine oral tablet 120 mg, 160 mg, 240 mg, 80 mg (Betapace) sotalol 120 mg tablet 120 mg (Betapace) sotalol af oral tablet 120 mg (Betapace) sotalol oral tablet 160 mg, 240 mg, 80 mg (Betapace) timolol maleate oral tablet 10 mg, 20 mg, 5 mg (Timolol Maleate) Calcium-Channel Blocking Agents cartia xt oral capsule,extended release 24hr 120 mg, 180 mg, 240 (Cardizem CD) mg, 300 mg diltiazem 24hr er 180 mg cap 180 mg (Cardizem CD) diltiazem 24hr er 360 mg cap once a (Cardizem CD) day dosage 360 mg www.centersplan.com/fida/participants 88

diltiazem hcl intravenous recon soln 100 mg diltiazem hcl intravenous solution 5 mg/ml diltiazem hcl oral capsule, extended release 180 mg, 360 mg, 420 mg diltiazem hcl oral capsule,extended release 12 hr 120 mg, 60 mg, 90 mg diltiazem hcl oral capsule,extended release 24hr 120 mg, 240 mg, 300 mg diltiazem hcl oral tablet 120 mg, 30 mg, 60 mg, 90 mg diltiazem hcl oral tablet extended release 24 hr 180 mg, 240 mg, 300 mg, 360 mg, 420 mg dilt-xr oral capsule,ext release degradable 120 mg, 180 mg, 240 mg matzim la oral tablet extended release 24 hr 180 mg, 240 mg, 300 mg, 360 mg, 420 mg taztia xt oral capsule, extended release 120 mg, 180 mg, 240 mg, 300 mg, 360 mg verapamil intravenous syringe 2.5 mg/ml verapamil oral capsule, 24 hr er pellet ct 100 mg, 200 mg, 300 mg verapamil oral capsule,ext rel. pellets 24 hr 120 mg, 180 mg, 240 mg, 360 mg verapamil oral tablet 120 mg, 40 mg, 80 mg verapamil oral tablet extended release 120 mg, 180 mg, 240 mg Cardiovascular Agents, Miscellaneous (Cardizem CD) (Cardizem CD) (Cardizem CD) (Cardizem CD) (Cardizem CD) (Cardizem CD) (Cardizem LA) (Cardizem CD) (Cardizem CD) (Cardizem CD) (Verapamil HCl) (Verelan Pm) (Verelan) (Calan) (Calan SR) www.centersplan.com/fida/participants 89

CORLANOR ORAL TABLET 5 ST MG, 7.5 MG DEMSER ORAL CAPSULE 250 MG digitek oral tablet 125 mcg (Lanoxin) QL (30 per 30 days) digitek oral tablet 250 mcg (Lanoxin) PA-HRM; QL (30 per 30 days) digox 125 mcg tablet 125 mcg (Lanoxin) QL (30 per 30 days) digox 250 mcg tablet 250 mcg (Lanoxin) PA-HRM; QL (30 per 30 days) digoxin 0.25 mg/ml syringe 250 PA-HRM (Digoxin) mcg/ml digoxin injection solution 250 PA-HRM (Digoxin) mcg/ml DIGOXIN ORAL SOLUTION 50 PA-HRM; QL (300 per MCG/ML 30 days) digoxin oral tablet 125 mcg (Lanoxin) QL (30 per 30 days) digoxin oral tablet 250 mcg (Lanoxin) PA-HRM; QL (30 per 30 days) dobutamine in d5w intravenous parenteral solution 1,000 mg/250 ml (Dobutamine (4,000 mcg/ml), 250 mg/250 ml (1 HCl/D5W) mg/ml), 500 mg/250 ml (2,000 mcg/ml) dobutamine intravenous solution (Dobutamine HCl) 250 mg/20 ml (12.5 mg/ml) dopamine in 5 % dextrose intravenous solution 200 mg/250 ml (800 mcg/ml), 400 mg/250 ml (1,600 mcg/ml), 800 mg/250 ml (3,200 mcg/ml) dopamine intravenous solution 200 mg/5 ml (40 mg/ml), 400 mg/5 ml (80 mg/ml), 800 mg/10 ml (80 mg/ml), 800 mg/5 ml (160 mg/ml) ephedrine sulfate injection solution 50 mg/ml (Dopamine HCl/D5W) (Dopamine HCl) (Ephedrine Sulfate) www.centersplan.com/fida/participants 90

epinephrine hcl (pf) intravenous solution 1 mg/ml (1 ml) epinephrine injection auto-injector 0.15 mg/0.15 ml, 0.3 mg/0.3 ml epinephrine injection solution 1 mg/ml (1 ml) epinephrine injection syringe 0.1 mg/ml EPIPEN 2-PAK INJECTION AUTO-INJECTOR 0.3 MG/0.3 ML EPIPEN JR 2-PAK INJECTION AUTO-INJECTOR 0.15 MG/0.3 ML ethamolin intravenous solution 5 % FIRAZYR SUBCUTANEOUS SYRINGE 30 MG/3 ML hydralazine injection solution 20 mg/ml hydralazine oral tablet 10 mg, 100 mg, 25 mg, 50 mg LANOXIN ORAL TABLET 187.5 MCG LANOXIN ORAL TABLET 62.5 MCG milrinone in 5 % dextrose intravenous piggyback 40 mg/200 ml (200 mcg/ml) milrinone intravenous solution 1 mg/ml norepinephrine bitartrate intravenous solution 1 mg/ml papaverine injection solution 30 mg/ml papaverine oral capsule, extended release 150 mg (Epinephrine HCl/PF) (Adrenaclick) (Epinephrine) (Epinephrine) (Ethanolamine Oleate) (Hydralazine HCl) (Hydralazine HCl) (Milrinone Lactate/D5W) (Milrinone Lactate) (Levophed Bitartrate) (Papaverine HCl) (Papaverine HCl) PA-HRM; QL (30 per 30 days) QL (30 per 30 days) PA PA www.centersplan.com/fida/participants 91

RANEXA ORAL TABLET EXTENDED RELEASE 12 HR 1,000 MG, 500 MG Dihydropyridines afeditab cr oral tablet extended release 30 mg, 60 mg (Adalat CC) amlodipine oral tablet 10 mg, 2.5 mg, 5 mg (Norvasc) amlodipine-benazepril oral capsule 10-20 mg, 10-40 mg, 2.5-10 mg, 5- (Lotrel) 10 mg, 5-20 mg, 5-40 mg amlodipine-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5- (Exforge) 320 mg amlodipine-valsartan-hcthiazid oral tablet 10-160-12.5 mg, 10-160-25 mg, 10-320-25 mg, 5-160-12.5 mg, (Exforge HCT) 5-160-25 mg AZOR ORAL TABLET 10-20 MG, 10-40 MG, 5-20 MG, 5-40 MG CLEVIPREX INTRAVENOUS EMULSION 50 MG/100 ML felodipine oral tablet extended release 24 hr 10 mg, 2.5 mg, 5 mg (Felodipine) isradipine oral capsule 2.5 mg, 5 mg (Isradipine) nicardipine oral capsule 20 mg, 30 mg (Nicardipine HCl) nifedical xl oral tablet extended release 24hr 30 mg, 60 mg (Procardia XL) nifedipine er 30 mg tablet f/c 30 mg (Adalat CC) nifedipine oral tablet extended release 24hr 30 mg (Adalat CC) nifedipine oral tablet extended release 24hr 60 mg, 90 mg (Procardia XL) Diuretics amiloride oral tablet 5 mg (Amiloride HCl) amiloride-hydrochlorothiazide oral tablet 5-50 mg (Amiloride/Hydroc hlorothiazide) ST www.centersplan.com/fida/participants 92

bumetanide injection solution 0.25 mg/ml (Bumetanide) bumetanide oral tablet 0.5 mg, 1 mg, 2 mg (Bumetanide) chlorothiazide oral tablet 250 mg, 500 mg (Chlorothiazide) chlorothiazide sodium intravenous recon soln 500 mg (Sodium Diuril) chlorthalidone oral tablet 25 mg, 50 mg (Chlorthalidone) DYRENIUM ORAL CAPSULE 100 MG, 50 MG furosemide injection solution 10 mg/ml (Furosemide) furosemide injection syringe 10 mg/ml (Furosemide) furosemide oral solution 10 mg/ml, 40 mg/5 ml (8 mg/ml) (Furosemide) furosemide oral tablet 20 mg, 40 mg, 80 mg (Lasix) hydrochlorothiazide oral capsule 12.5 mg (Microzide) hydrochlorothiazide oral tablet 12.5 (Hydrochlorothiazi mg, 25 mg, 50 mg de) indapamide oral tablet 1.25 mg, 2.5 mg (Indapamide) methyclothiazide oral tablet 5 mg (Methyclothiazide) metolazone oral tablet 10 mg, 2.5 mg, 5 mg (Zaroxolyn) torsemide oral tablet 10 mg, 100 mg, 20 mg, 5 mg (Demadex) triamterene-hydrochlorothiazid oral capsule 37.5-25 mg, 50-25 mg (Dyazide) triamterene-hydrochlorothiazid oral tablet 37.5-25 mg, 75-50 mg (Maxzide) Dyslipidemics www.centersplan.com/fida/participants 93

amlodipine-atorvastatin oral tablet 10-10 mg, 10-20 mg, 10-40 mg, 10-80 mg, 2.5-10 mg, 2.5-20 mg, 2.5-40 (Caduet) mg, 5-10 mg, 5-20 mg, 5-40 mg, 5-80 mg atorvastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg (Lipitor) cholestyramine light oral powder in packet 4 gram (Questran) cholestyramine packet 4 gram (Questran) colestipol hcl granules packet 5 gram (Colestid) colestipol oral granules 5 gram (Colestid) colestipol oral tablet 1 gram (Colestid) CRESTOR ORAL TABLET 10 MG, 20 MG, 40 MG, 5 MG endur-acin sr 500 mg tablet 500 mg * (Slo-Niacin) fenofibrate micronized oral capsule 130 mg, 134 mg, 200 mg, 43 mg, 67 (Lofibra) mg fenofibrate nanocrystallized oral tablet 145 mg, 48 mg (Tricor) fenofibrate oral tablet 120 mg, 160 mg, 40 mg, 54 mg (Lofibra) fenofibric acid (choline) oral capsule,delayed release(dr/ec) 135 (Trilipix) mg, 45 mg fenofibric acid oral tablet 105 mg, 35 mg (Fibricor) gemfibrozil oral tablet 600 mg (Lopid) JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 30 MG, 40 MG, 5 MG, 60 MG KYNAMRO SUBCUTANEOUS SYRINGE 200 MG/ML lovastatin oral tablet 10 mg, 20 mg, 40 mg (Mevacor) PA PA; QL (4 per 28 days) www.centersplan.com/fida/participants 94

niacin 50 mg tablet 50 mg * (Slo-Niacin) niacin 500 mg capsule sa 500 mg * (Niacin) niacin 500 mg tablet 500 mg * (Slo-Niacin) niacin oral tablet extended release 24 hr 1,000 mg, 500 mg, 750 mg (Niaspan) niacin tr 500 mg caplet caplet 500 mg * (Slo-Niacin) niacinamide 500 mg tablet 500 mg * (Niacinamide) niacor oral tablet 500 mg (Niacin) omega-3 acid ethyl esters oral capsule 1 gram (Lovaza) PRALUENT PEN SUBCUTANEOUS PEN INJECTOR 150 MG/ML, 75 MG/ML PRALUENT SYRINGE SUBCUTANEOUS SYRINGE 150 MG/ML, 75 MG/ML pravastatin oral tablet 10 mg, 20 mg, 40 mg, 80 mg (Pravachol) prevalite oral powder 4 gram (Cholestyramine/A spartame) prevalite packet outer 4 gram REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR 140 MG/ML REPATHA SYRINGE SUBCUTANEOUS SYRINGE 140 MG/ML simvastatin oral tablet 10 mg, 20 mg, 40 mg, 5 mg (Cholestyramine/A spartame) (Zocor) PA; QL (2 per 28 days) PA; QL (2 per 28 days) PA; QL (3 per 28 days) PA; QL (3 per 28 days) simvastatin oral tablet 80 mg (Zocor) QL (30 per 30 days) VASCEPA ORAL CAPSULE 1 GRAM WELCHOL ORAL POWDER IN PACKET 3.75 GRAM www.centersplan.com/fida/participants 95

WELCHOL ORAL TABLET 625 MG ZETIA ORAL TABLET 10 MG Renin-Angiotensin- Aldosterone System Inhibitors eplerenone oral tablet 25 mg, 50 mg (Inspra) spironolactone oral tablet 100 mg, 25 mg, 50 mg (Aldactone) spironolacton-hydrochlorothiaz oral (Aldactazide) tablet 25-25 mg Vasodilators BIDIL ORAL TABLET 20-37.5 MG isosorbide dinitrate oral tablet 10 mg, 20 mg, 30 mg, 5 mg (Isochron) isosorbide dinitrate oral tablet extended release 40 mg (Isochron) isosorbide dinitrate sublingual (Isosorbide tablet 2.5 mg, 5 mg Dinitrate) isosorbide mononitrate oral tablet (Isosorbide 10 mg, 20 mg Mononitrate) isosorbide mononitrate oral tablet extended release 24 hr 120 mg, 30 (Imdur) mg, 60 mg minitran transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.6 mg/hr (Nitro-Dur) minitran transdermal patch 24 hour 0.4 mg/hr (Nitro-Dur) minoxidil oral tablet 10 mg, 2.5 mg (Minoxidil) NITRO-BID TRANSDERMAL OINTMENT 2 % nitroglycerin in 5 % dextrose intravenous solution 100 mg/250 ml (Nitroglycerin/D5 (400 mcg/ml), 25 mg/250 ml (100 W) mcg/ml), 50 mg/250 ml (200 mcg/ml) QL (30 per 30 days) QL (60 per 30 days) www.centersplan.com/fida/participants 96

nitroglycerin intravenous solution 50 mg/10 ml (5 mg/ml) nitroglycerin transdermal patch 24 hour 0.1 mg/hr, 0.2 mg/hr, 0.6 mg/hr nitroglycerin transdermal patch 24 hour 0.4 mg/hr NITROSTAT SUBLINGUAL TABLET 0.3 MG, 0.4 MG, 0.6 MG PROGLYCEM ORAL SUSPENSION 50 MG/ML Central Nervous System Agents Central Nervous System Agents AMPYRA ORAL TABLET EXTENDED RELEASE 12 HR 10 MG caffeine citrated intravenous solution 60 mg/3 ml (20 mg/ml) caffeine citrated oral solution 60 mg/3 ml (20 mg/ml) caffeine-sodium benzoate injection solution 250 mg/ml (125 mg/ml caffeine) clonidine hcl oral tablet extended release 12 hr 0.1 mg dexmethylphenidate oral tablet 10 mg, 2.5 mg, 5 mg dextroamphetamine oral capsule, extended release 10 mg, 15 mg, 5 mg dextroamphetamine oral tablet 10 mg, 5 mg dextroamphetamine-amphetamine oral capsule,extended release 24hr 10 mg, 15 mg, 5 mg (Nitroglycerin) (Nitro-Dur) (Nitro-Dur) (Cafcit) (Cafcit) (Caffeine/Sodium Benzoate) (Kapvay) (Focalin) (Dexedrine) (Dexedrine) (Adderall XR) QL (30 per 30 days) QL (60 per 30 days) PA; QL (60 per 30 days) QL (60 per 30 days) QL (120 per 30 days) QL (180 per 30 days) QL (30 per 30 days) www.centersplan.com/fida/participants 97

dextroamphetamine-amphetamine oral capsule,extended release 24hr 20 mg, 25 mg, 30 mg dextroamphetamine-amphetamine oral tablet 10 mg, 12.5 mg, 15 mg, 20 mg, 30 mg, 5 mg, 7.5 mg flumazenil intravenous solution 0.1 mg/ml guanfacine oral tablet extended release 24 hr 1 mg, 2 mg, 3 mg, 4 mg lithium carbonate oral capsule 150 mg, 300 mg, 600 mg lithium carbonate oral tablet 300 mg lithium carbonate oral tablet extended release 300 mg, 450 mg lithium citrate oral solution 8 meq/5 ml methylphenidate cd 20 mg cap 20 mg methylphenidate cd 40 mg cap 40 mg methylphenidate oral capsule, er biphasic 30-70 10 mg, 50 mg, 60 mg methylphenidate oral capsule, er biphasic 30-70 30 mg methylphenidate oral capsule,er biphasic 50-50 20 mg, 40 mg methylphenidate oral solution 10 mg/5 ml, 5 mg/5 ml methylphenidate oral tablet 10 mg, 20 mg, 5 mg methylphenidate oral tablet extended release 10 mg, 20 mg methylphenidate oral tablet extended release 24hr 18 mg, 27 mg, 54 mg (Adderall XR) (Adderall) (Romazicon) (Intuniv) (Lithium Carbonate) (Lithobid) (Lithobid) (Lithium Citrate) (Metadate Cd) (Metadate Cd) (Metadate Cd) (Metadate Cd) (Metadate Cd) (Methylin) (Ritalin) (Methylphenidate HCl) (Concerta) QL (60 per 30 days) QL (60 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (30 per 30 days) QL (60 per 30 days) QL (30 per 30 days) QL (900 per 30 days) QL (90 per 30 days) QL (90 per 30 days) QL (30 per 30 days) www.centersplan.com/fida/participants 98

methylphenidate oral tablet extended release 24hr 36 mg (Concerta) NUEDEXTA ORAL CAPSULE 20-10 MG QUILLIVANT XR ORAL SUSPENSION,EXT REL 24HR,RECON 5 MG/ML (25 MG/5 ML) riluzole oral tablet 50 mg (Rilutek) SAVELLA ORAL TABLET 100 MG, 12.5 MG, 25 MG, 50 MG SAVELLA ORAL TABLETS,DOSE PACK 12.5 MG (5)-25 MG(8)-50 MG(42) STRATTERA ORAL CAPSULE 10 MG, 100 MG, 18 MG, 25 MG, 40 MG, 60 MG, 80 MG tetrabenazine oral tablet 12.5 mg, 25 mg (Xenazine) Contraceptives Contraceptives AFTERA 1.5 MG TABLET 1.5 MG * 3 $0 altavera (28) oral tablet 0.15-0.03 mg (Amethyst) alyacen 1/35 (28) oral tablet 1-35 mg-mcg (Modicon) alyacen 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg (Modicon) amethia lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (Seasonique) (7) amethia oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (Seasonique) (7) apri oral tablet 0.15-0.03 mg (Desogen) aranelle (28) oral tablet 0.5/1/0.5-35 mg-mcg (Modicon) QL (60 per 30 days) QL (60 per 30 days) QL (60 per 30 days) QL (60 per 30 days) PA; QL (112 per 28 days) QL (6 per 365 days) QL (91 per 84 days) QL (91 per 84 days) www.centersplan.com/fida/participants 99

ashlyna oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (Seasonique) (7) aubra oral tablet 0.1-20 mg-mcg (Amethyst) aviane oral tablet 0.1-20 mg-mcg (Amethyst) azurette (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 (Mircette) balziva (28) oral tablet 0.4-35 mgmcg (Modicon) bekyree (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 (Mircette) blisovi 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) (Loestrin Fe) blisovi fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) (Loestrin Fe) blisovi fe 1/20 (28) oral tablet 1 mg- (Loestrin Fe) 20 mcg (21)/75 mg (7) briellyn oral tablet 0.4-35 mg-mcg (Modicon) camila oral tablet 0.35 mg (Nor-Q-D) camrese lo oral tablets,dose pack,3 month 0.10 mg-20 mcg (84)/10 mcg (7) camrese oral tablets,dose pack,3 month 0.15 mg-30 mcg (84)/10 mcg (7) caziant (28) oral tablet 0.1/.125/.15-25 mg-mcg cryselle (28) oral tablet 0.3-30 mgmcg cyclafem 1/35 (28) oral tablet 1-35 mg-mcg cyclafem 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg (Seasonique) (Seasonique) (Desogen) (Norgestrel-Ethinyl Estradiol) (Modicon) (Modicon) cyred oral tablet 0.15-0.03 mg (Desogen) dasetta 1/35 (28) oral tablet 1-35 mg-mcg (Modicon) dasetta 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg (Modicon) QL (91 per 84 days) QL (91 per 84 days) www.centersplan.com/fida/participants 100

daysee oral tablets,dose pack,3 QL (91 per 84 days) month 0.15 mg-30 mcg (84)/10 mcg (7) (Seasonique) deblitane oral tablet 0.35 mg (Nor-Q-D) delyla (28) oral tablet 0.1-20 mgmcg (Amethyst) desog-e.estradiol/e.estradiol oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 (Mircette) desogestrel-ethinyl estradiol oral tablet 0.15-0.03 mg (Desogen) drospirenone-ethinyl estradiol oral tablet 3-0.02 mg, 3-0.03 mg (Yaz) econtra ez 1.5 mg tablet inner 1.5 QL (6 per 365 days) (Aftera) mg * elinest oral tablet 0.3-30 mg-mcg (Norgestrel-Ethinyl Estradiol) ELLA ORAL TABLET 30 MG QL (6 per 365 days) emoquette oral tablet 0.15-0.03 mg (Desogen) enpresse oral tablet 50-30 (6)/75-40 (5)/125-30(10) (Amethyst) enskyce oral tablet 0.15-0.03 mg (Desogen) errin oral tablet 0.35 mg (Nor-Q-D) estarylla oral tablet 0.25-35 mg-mcg (Ortho-Cyclen) falmina (28) oral tablet 0.1-20 mgmcg (Amethyst) gianvi (28) oral tablet 3-0.02 mg (Yaz) gildagia oral tablet 0.4-35 mg-mcg (Modicon) gildess 1.5/30 (21) oral tablet 1.5-30 (Loestrin) mg-mcg gildess 1/20 (21) oral tablet 1-20 mg-mcg (Loestrin) gildess 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) (Loestrin Fe) gildess fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) (Loestrin Fe) gildess fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) (Loestrin Fe) heather oral tablet 0.35 mg (Nor-Q-D) www.centersplan.com/fida/participants 101

introvale oral tablets,dose pack,3 (Levonorgestrelmonth 0.15-30 mg-mcg Ethin Estradiol) jencycla oral tablet 0.35 mg (Nor-Q-D) jolessa oral tablets,dose pack,3 (Levonorgestrelmonth 0.15-30 mg-mcg Ethin Estradiol) jolivette oral tablet 0.35 mg (Nor-Q-D) juleber oral tablet 0.15-0.03 mg (Desogen) junel 1.5/30 (21) oral tablet 1.5-30 mg-mcg (Loestrin) junel 1/20 (21) oral tablet 1-20 mgmcg (Loestrin) junel fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) (Loestrin Fe) junel fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) (Loestrin Fe) junel fe 24 oral tablet 1 mg-20 mcg (24)/75 mg (4) (Loestrin Fe) kariva (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 (Mircette) kelnor 1/35 (28) oral tablet 1-35 mg-mcg (Demulen 1-50-21) kimidess (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 (Mircette) kurvelo oral tablet 0.15-0.03 mg (Amethyst) l norgest/e.estradiol-e.estrad oral tablets,dose pack,3 month 0.10 mg- 20 mcg (84)/10 mcg (7), 0.15 mg-30 (Seasonique) mcg (84)/10 mcg (7) larin 1.5/30 (21) oral tablet 1.5-30 mg-mcg (Loestrin) larin 1/20 (21) oral tablet 1-20 mgmcg (Loestrin) larin 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) (Loestrin Fe) larin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) (Loestrin Fe) larin fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) (Loestrin Fe) QL (91 per 84 days) QL (91 per 84 days) QL (91 per 84 days) www.centersplan.com/fida/participants 102

leena 28 oral tablet 0.5/1/0.5-35 mg-mcg (Modicon) lessina oral tablet 0.1-20 mg-mcg (Amethyst) levonest (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10) (Amethyst) levonor-eth estrad 0.15-0.03 outer QL (91 per 84 days) (Amethyst) 0.15-0.03 mg levonorgestrel 1.5 mg tablet (otc) QL (6 per 365 days) (Aftera) 1.5 mg * levonorgestrel oral tablet 0.75 mg (Plan B One-Step) QL (12 per 365 days) levonorgestrel oral tablet 1.5 mg (Plan B One-Step) QL (6 per 365 days) levonorgestrel-ethinyl estrad oral tablet 0.1-20 mg-mcg (Amethyst) levonorgestrel-ethinyl estrad oral QL (91 per 84 days) tablets,dose pack,3 month 0.15-30 mg-mcg (Amethyst) levonorg-eth estrad triphasic oral QL (91 per 84 days) tablet 50-30 (6)/75-40 (5)/125-30(10) (Amethyst) levora-28 oral tablet 0.15-0.03 mg (Amethyst) lomedia 24 fe oral tablet 1 mg-20 mcg (24)/75 mg (4) (Loestrin Fe) loryna (28) oral tablet 3-0.02 mg (Yaz) low-ogestrel (28) oral tablet 0.3-30 (Norgestrel-Ethinyl mg-mcg Estradiol) lutera (28) oral tablet 0.1-20 mgmcg (Amethyst) lyza oral tablet 0.35 mg (Nor-Q-D) marlissa oral tablet 0.15-0.03 mg (Amethyst) microgestin 1.5/30 (21) oral tablet 1.5-30 mg-mcg (Loestrin) microgestin 1/20 (21) oral tablet 1-20 mg-mcg (Loestrin) microgestin fe 1.5/30 (28) oral tablet 1.5 mg-30 mcg (21)/75 mg (7) (Loestrin Fe) microgestin fe 1/20 (28) oral tablet 1 mg-20 mcg (21)/75 mg (7) (Loestrin Fe) www.centersplan.com/fida/participants 103

mono-linyah oral tablet 0.25-35 mgmcg (Ortho-Cyclen) mononessa (28) oral tablet 0.25-35 mg-mcg (Ortho-Cyclen) my way 1.5 mg tablet (otc) 1.5 mg * (Aftera) QL (6 per 365 days) myzilra oral tablet 50-30 (6)/75-40 (5)/125-30(10) (Amethyst) necon 0.5/35 (28) oral tablet 0.5-35 mg-mcg (Modicon) necon 1/35 (28) oral tablet 1-35 mgmcg (Modicon) necon 1/50 (28) oral tablet 1-50 mgmcg (Norinyl 1+50) necon 10/11 (28) oral tablet 0.5-35/1-35 mg-mcg/mg-mcg (Modicon) necon 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg (Modicon) next choice one dose 1.5 mg tb (otc) QL (6 per 365 days) (Aftera) 1.5 mg * next choice one dose oral tablet 1.5 QL (6 per 365 days) (Plan B One-Step) mg nikki (28) oral tablet 3-0.02 mg (Yaz) nora-be oral tablet 0.35 mg (Nor-Q-D) norethindrone (contraceptive) oral tablet 0.35 mg (Nor-Q-D) norethindrone ac-eth estradiol oral tablet 1-20 mg-mcg (Loestrin) norethindrone-e.estradiol-iron oral tablet 1 mg-20 mcg (24)/75 mg (4) (Loestrin Fe) norg-ee 0.18-0.215-0.25/0.035 0.18/0.215/0.25 mg-35 mcg (28) (Ortho-Cyclen) norgestimate-ethinyl estradiol oral tablet 0.18/0.215/0.25 mg-25 mcg, (Ortho-Cyclen) 0.25-35 mg-mcg norlyroc oral tablet 0.35 mg (Nor-Q-D) nortrel 0.5/35 (28) oral tablet 0.5-35 (Modicon) mg-mcg www.centersplan.com/fida/participants 104

nortrel 1/35 (21) oral tablet 1-35 mg-mcg (Modicon) nortrel 1/35 (28) oral tablet 1-35 mg-mcg (Modicon) nortrel 7/7/7 (28) oral tablet 0.5/0.75/1 mg- 35 mcg (Modicon) NUVARING VAGINAL RING ST; QL (1 per 28 days) 0.12-0.015 MG/24 HR ocella oral tablet 3-0.03 mg (Yaz) ogestrel (28) oral tablet 0.5-50 mgmcg Estradiol) (Norgestrel-Ethinyl opcicon one-step 1.5 mg tablet 1.5 QL (6 per 365 days) (Aftera) mg * orsythia oral tablet 0.1-20 mg-mcg (Amethyst) philith oral tablet 0.4-35 mg-mcg (Modicon) pimtrea (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 (Mircette) pirmella oral tablet 0.5/0.75/1 mg- 35 mcg, 1-35 mg-mcg (Modicon) PLAN B ONE-STEP 1.5 MG QL (6 per 365 days) 3 $0 TABLET (OTC) 1.5 MG * portia oral tablet 0.15-0.03 mg (Amethyst) previfem oral tablet 0.25-35 mg-mcg (Ortho-Cyclen) quasense oral tablets,dose pack,3 (Levonorgestrel- QL (91 per 84 days) month 0.15-30 mg-mcg Ethin Estradiol) react 1.5 mg tablet 1.5 mg * (Aftera) QL (6 per 365 days) reclipsen (28) oral tablet 0.15-0.03 mg (Desogen) setlakin oral tablets,dose pack,3 (Levonorgestrel- QL (91 per 84 days) month 0.15-30 mg-mcg Ethin Estradiol) sharobel oral tablet 0.35 mg (Nor-Q-D) sprintec (28) oral tablet 0.25-35 mgmcg (Ortho-Cyclen) sronyx oral tablet 0.1-20 mg-mcg (Amethyst) syeda oral tablet 3-0.03 mg (Yaz) tarina fe 1/20 (28) oral tablet 1 mg- 20 mcg (21)/75 mg (7) (Loestrin Fe) www.centersplan.com/fida/participants 105

tilia fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) (Loestrin Fe) tri-estarylla oral tablet 0.18/0.215/0.25 mg-35 mcg (28) (Ortho-Cyclen) tri-legest fe oral tablet 1-20(5)/1-30(7) /1mg-35mcg (9) (Loestrin Fe) tri-linyah oral tablet 0.18/0.215/0.25 mg-35 mcg (28) (Ortho-Cyclen) tri-lo-estarylla oral tablet 0.18/0.215/0.25 mg-25 mcg (Ortho-Cyclen) tri-lo-marzia oral tablet 0.18/0.215/0.25 mg-25 mcg (Ortho-Cyclen) tri-lo-sprintec oral tablet 0.18/0.215/0.25 mg-25 mcg (Ortho-Cyclen) trinessa (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) (Ortho-Cyclen) tri-previfem (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) (Ortho-Cyclen) tri-sprintec (28) oral tablet 0.18/0.215/0.25 mg-35 mcg (28) (Ortho-Cyclen) trivora (28) oral tablet 50-30 (6)/75-40 (5)/125-30(10) (Amethyst) velivet triphasic regimen (28) oral tablet 0.1/.125/.15-25 mg-mcg (Desogen) vestura (28) oral tablet 3-0.02 mg (Yaz) vienva oral tablet 0.1-20 mg-mcg (Amethyst) viorele (28) oral tablet 0.15-0.02 mgx21 /0.01 mg x 5 (Mircette) vyfemla (28) oral tablet 0.4-35 mgmcg (Modicon) wera (28) oral tablet 0.5-35 mg-mcg (Modicon) xulane transdermal patch weekly 150-35 mcg/24 hr (Ortho Evra) zarah oral tablet 3-0.03 mg (Yaz) zenchent (28) oral tablet 0.4-35 mgmcg (Modicon) zovia 1/35e (28) oral tablet 1-35 mg-mcg (Demulen 1-50-21) QL (3 per 28 days) www.centersplan.com/fida/participants 106

zovia 1/50e (28) oral tablet 1-50 mg-mcg Cough And Cold Products Cough And Cold Products 15dm-5peh-2cpm liquid strawberry 2-5-15 mg/5 ml * 25cpd-200gfn liquid 25-200 mg/5 ml * 30pse-150gfn-15dm liquid 30-15- 150 mg/5 ml * 3brm-15dm-30pse liquid 3-30-15 mg/5 ml * 3brm-30dm-50pse liquid (otc) 3-50- 30 mg/5 ml * actinel pediatric liquid 15-5-50 mg/5 ml * adt robitussin linger cold syr 15 mg/5 ml * adt robitussin peak cld dm max 10-200 mg/5 ml * adult robitussin peak cold liq nondrowsy 10-100 mg/5 ml * adult wal-tussin dm max liq a/f,cherry menthol 10-200 mg/5 ml * adult wal-tussin dm syrup a/f,cherry,adult 10-100 mg/5 ml * adult wal-tussin liquid 100 mg/5 ml * (Demulen 1-50-21) (Chlorpheniramine/ Phenyleph/Dm) (Chlophedianol HCl/Guaifenesin) (Trispec Pse) (Brompheniramine/ Pseudoephed/Dm) (Brompheniramine/ Pseudoephed/Dm) (Trispec Pse) (Dextromethorphan Hbr) (G-Zyncof) (G-Zyncof) (G-Zyncof) (Cough Formula Dm) (Robitussin Mucus-Chest Congest) alka-seltzer plus mucus-conges 10- (Guaifenesin/Dextr 200 mg * omethorphan) ambi 10peh-4cpm-20dm tablet 4-10- (Chlorpheniramine/ 20 mg * Phenyleph/Dm) ambi 20dm-4cpm tablet 4-20 mg * (Coricidin Hbp) ambi 40pse-400gfn-20dm tablet 40- (Guaifenesin/Dm/P 20-400 mg * seudoephedrine) ambi 60pse-4cpm-20dm tablet 4-60- (Chlorpheniramin/ 20 mg * Pseudoephed/Dm) www.centersplan.com/fida/participants 107

benzonatate 100 mg capsule 100 mg * (Zonatuss) 3 $0 benzonatate 150 mg capsule 150 mg * (Zonatuss) 3 $0 benzonatate 200 mg capsule 200 mg * (Zonatuss) 3 $0 bio-dtuss dmx liquid 1-30-20 mg/5 (Brompheniramine/ ml * Pseudoephed/Dm) bionel pediatric liquid 15-5-50 mg/5 ml * (Trispec Pse) biospec dmx liquid 15-25 mg/5 ml * (G-Zyncof) bp 8 cough oral suspension a/f, (Guaifenesin/Dm/P grape (otc) 30-15-175 mg/5 ml * seudoephedrine) bpm-pse-dm liquid a/f, cotton candy (Brompheniramine/ (otc) 4-20-20 mg/5 ml * Pseudoephed/Dm) bromfed dm cough syrup 2-30-10 (Brompheniramine/ mg/5 ml * Pseudoephed/Dm) 3 $0 bromphenex dm syrup (otc) 4-60-30 (Brompheniramine/ mg/5 ml * Pseudoephed/Dm) bromphenir-pseudoephed-dm syr (Brompheniramine/ (rx) 2-30-10 mg/5 ml * Pseudoephed/Dm) brom-pse-dm cough syrup butter (Brompheniramine/ scotch (otc) 2-30-10 mg/5 ml * Pseudoephed/Dm) centergy dm pediatric drops 1-2-3 (Chlorpheniramine/ mg/ml * Phenyleph/Dm) cheracol d cough formula 10-100 mg/5 ml * (G-Zyncof) cheratussin dac syrup 30-10-100 mg/5 ml * (Tusnel C) child sudafed pe cough-cold lq 2.5-5 (Dextromethorphan mg/5 ml * /Phenylephrine) child triaminic cgh-congst syr 5-100 (Cough Formula mg/5 ml * Dm) child wal-tussin 7.5 mg odt 7.5 mg * (Dextromethorphan Hbr) children's mucinex cough liq a/f 5-100 mg/5 ml * (G-Zyncof) www.centersplan.com/fida/participants 108

children's silfedrine liq 15 mg/5 ml (Pseudoephedrine * HCl) (Robitussin chl mucinex chest congest liq a/f Mucus-Chest 100 mg/5 ml * Congest) cold multi-symptom day-night (Dm pseudoephedrine-free 2-5-10-325 Hb/Pe/Acetaminop mg * hen/chlorph) (Dm cold relief multi-symp caplet cplt,12 Hb/Pe/Acetaminop day,12 night 2-5-10-325 mg * hen/chlorph) (Dcold-flu relief liquid 12.5-30-1,000 Methorphan/Aceta mg/30 ml * min/doxylamn) (Guaifenesin/Pseud congestac tablet 60-400 mg * oephedrne HCl) (Dcoricidin hbp cold-multi sympt 6.25- Methorphan/Aceta 15-325 mg/15 ml * min/doxylamn) (Guaifenesin/Dextr coricidin hbp softgel 10-200 mg * omethorphan) cough & cold tablet 4-30 mg * (Coricidin Hbp) cvs chest cong relief pe tab 10-400 (Maxiphen) mg * cvs chest congest relief dm tb 20- (Allfen Dm) 400 mg * childs sudafed 15 mg/5 ml liq nondrowsy,a/f,s/f 15 mg/5 ml * codituss dm syrup 8.33-5-10 mg/5 cold-flu relief d/n softgel 10-5- congest-eze 60-400 mg caplet 60- cvs child cold-cough day liq 2.5-5 (Pseudoephedrine (Pyrilamine/Pe/De (Vicks Dayquil- (Guaifenesin/Pseud (Dextromethorphan ml * 325mg(d)/ 15-325-6.25mg * 400 mg * mg/5 ml * HCl) xtromethorphan) Nyquil) oephedrne HCl) /Phenylephrine) www.centersplan.com/fida/participants 109

cvs child's chest congest liq 100 mg/5 ml * cvs cough & sore throat susp 160-5 mg/5 ml * cvs cough relief liquid a/f, grape 15 mg/5 ml * cvs daytime-nighttime cold-flu multi-symp,twin pack 6.25-5-10-325 mg/15 ml * cvs tussin cgh 15 mg liq gels nondrowsy, liq gels 15 mg * cvs tussin dm cough-chest liq 10-200 mg/5 ml * cvs tussin max-str syrup 15 mg/5 ml * daytime cold & cough liquid 1,000-30 mg/30 ml * daytime cold & flu liquid a/f, glutenfree 5-10-325 mg/15 ml * (Robitussin Mucus-Chest Congest) (Acetaminophen/D extromethorphan) (Dextromethorphan Hbr) (Dm/Pe/Acetamino phen/doxylamine) (Robitussin) (G-Zyncof) (Dextromethorphan Hbr) (Triaminic) (D- Methorphan/Pe/Ac etaminophen) (Dextromethorphan Hbr) (Dextromethorphan Hb/Doxylamine) daytime cough liquid a/f, gluten-free 5 mg/5 ml * daytime-nighttime cough liquid 15mg/15ml(d)/ 12.5-30mg/30ml * delsym cough+chest cngst dm lq 5-100 mg/5 ml * (G-Zyncof) despec-dm tablet 30-10-200 mg * (Guaifenesin/Dm/P seudoephedrine) dextromethorphan er 30 mg/5 ml 30 mg/5 ml * (Delsym) diabetic tussin dm liquid 10-100 mg/5 ml * (G-Zyncof) diabetic tussin dm max-str liq 10-200 mg/5 ml * (G-Zyncof) ed bron gp liquid 5-100 mg/5 ml * (Despec) entre-cough liquid 30-15-175 mg/5 ml * (Trispec Pse) www.centersplan.com/fida/participants 110

expectorant 100 mg/5 ml syrup 100 mg/5 ml * expectorant dm cough liquid 20-300 mg/5 ml * expectorant max cough-cold 30-15 mg/5 ml * geri-tussin dm syrup 10-100 mg/5 ml * guaifenesin 200 mg tablet (otc) 200 mg * guaifenesin dac oral solution 30-10- 100 mg/5 ml * guaifenesin er 600 mg tablet 600 mg * head congestion day-night pack 2-5- 10-325 mg * (Robitussin Mucus-Chest Congest) (G-Zyncof) (Dextromethorphan /Pseudoephed) (Cough Formula Dm) (Allfen) (Tusnel C) (Mucinex) (Dm Hb/Pe/Acetaminop hen/chlorph) hydrocodone-chlorphen er susp 10- (Tussionex) 3 $0 8 mg/5 ml * hydrocodone-homatropine 5-1.5 mg (Tussigon) 3 $0 tablet 5-1.5 mg * (Hydrocodone hydromet syrup 5-1.5 mg/5 ml * Bit/Homatrop Me- 3 $0 Br) liquibid d-r tablet 10-400 mg * (Maxiphen) lohist-dm syrup 2-5-10 mg/5 ml * (Ala-Hist Dm) 3 $0 lortuss ex liquid 30-10-100 mg/5 ml (Tusnel C) * mar-cof bp liquid 2-30-7.5 mg/5 ml (Bromphenira/Pseu 3 $0 * doephed/codein) mar-cof cg liquid 7.5-225 mg/5 ml * (M-Clear Wc) 3 $0 mucus dm 600-30 mg tablet 30-600 (Mucinex Dm) mg * mucus dm max tablet 60-1,200 mg * (Mucinex Dm) mesehist dm oral syrup 2-15-15 (Chlorpheniramin/ mg/5 ml * Pseudoephed/Dm) www.centersplan.com/fida/participants 111

mucus relief 400 mg tablet d/f 400 mg * (Allfen) nasal-sinus decongest tab 30 mg * (Pseudoephedrine HCl) nasohist dm pediatric drops 1-2-3 (Chlorpheniramine/ mg/ml * Phenyleph/Dm) neo-tuss liquid 30-200 mg/5 ml * (G-Zyncof) NEXAFED 30 MG TABLET 30 MG * NIGHT TIME COLD-FLU RLF SFTGL SFTGL, MULTI- SYMPTOM 6.25-15-325 MG * (Dnight time cough & sore throat 12.5- Methorphan/Aceta 30-1,000 mg/30 ml * min/doxylamn) nighttime cough liquid gluten-free, (Dextromethorphan cherry 6.25-15 mg/15 ml * Hb/Doxylamine) nighttime d cold-flu rlf liq multisymptom,cherry 6.25-30-15-500 mg/15 ml * nohist-dm liquid 4-10-15 mg/5 ml * pecgen dmx 125-15 mg/5 ml liq 15-125 mg/5 ml * pedia relief cough-cold liquid a/f, cherry 1-15-5 mg/5 ml * pediacare multi-symt cold liq non drowsy, grape 2.5-5 mg/5 ml * phenylhistine dh liquid (otc) 2-30-10 mg/5 ml * poly-tussin liquid 9.375-10 mg/5 ml * promethazine vc-codeine syrup 6.25-5-10 mg/5 ml * promethazine-codeine syrup 6.25-10 mg/5 ml * (Dm/P- Ephed/Acetaminop h/doxylam) (Chlorpheniramine/ Phenyleph/Dm) (G-Zyncof) (Chlorpheniramin/ Pseudoephed/Dm) (Dextromethorphan /Phenylephrine) (P-Ephed HCl/Cod/Chlorphe nir) (Chlorcyclizine/Co deine) (Promethazine/Phe nyleph/codeine) (Promethazine HCl/Codeine) 3 $0 3 $0 www.centersplan.com/fida/participants 112

promethazine-dm syrup 6.25-15 (Promethazine/Dex mg/5 ml * tromethorphan) 3 $0 pseudoephed 30 mg/5 ml soln 30 (Pseudoephedrine mg/5 ml * HCl) pseudoephedrine 30 mg tablet 30 (Pseudoephedrine mg * HCl) pseudoephedrine 60 mg tablet exstr, non drowsy (otc) 60 mg * HCl) (Pseudoephedrine (Dpv flu relief therapy liquid daytime Methorphan/Pe/Ac 5-10-325 mg/15 ml * etaminophen) (Dm/Ppv night-time softgel multisympt.,softgel 6.25-30-15-325 mg * Ephed/Acetaminop h/doxylam) pv tussin pe liquid 5-100 mg/5 ml * (Despec) q-tapp dm elixir 1-15-5 mg/5 ml * (Brompheniramine/ Pseudoephed/Dm) (Robitussin q-tussin 100 mg/5 ml solution a/f, Mucus-Chest non-drowsy 100 mg/5 ml * Congest) q-tussin dm syrup 10-100 mg/5 ml * (Cough Formula Dm) ra child plus cough-runny nose pseudoephedrine free 1-5-160 mg/5 ml * ra daytime-nighttime softgel cold-flu relief 10-5-325mg(d)/ 15-325- 6.25mg * ra flu formula gelcap 12.5-5-10-325 mg * ra maximum strength flu tablet 2-15-500 mg * ra mucus relief 400 mg tablet 400 mg * ra multi-symptom cold caplet nighttime,cplt 2-5-10-325 mg * (Dextromethorphn/ Acetaminoph/Cp) (Vicks Dayquil- Nyquil) (Dm/Pe/Acetamino ph/diphenhydram) (Coricidin Hbp) (Allfen) (Dm Hb/Pe/Acetaminop hen/chlorph) www.centersplan.com/fida/participants 113

ra tussin dm syrup a/f 10-100 mg/5 (Cough Formula ml * Dm) refenesen 200 mg tablet 200 mg * (Allfen) refenesen pe caplet 10-400 mg * (Maxiphen) relcof c liquid 6.3-100 mg/5 ml * (M-Clear Wc) 3 $0 REZIRA SOLUTION 60-5 MG/5 ML * 3 $0 robafen 100 mg/5 ml syrup 100 mg/5 ml * robafen cough 15 mg liquidgel nondrowsy,liquidgel 15 mg * robafen-dm syrup 10-100 mg/5 ml * robitussin cough-chest-cong dm 10-200 mg * ROBITUSSIN LONG-ACTING LIQ 1-7.5 MG/5 ML * robitussin pediatric cough syp a/f,long-acting 7.5 mg/5 ml * rydex liquid 1.3-10-6.3 mg/5 ml * rynex dm liquid a/f, prof use only 1-2.5-5 mg/5 ml * safetussin dm liquid 10-100 mg/5 ml * scot-tussin 100 mg/5 ml liq 100 mg/5 ml * scot-tussin dm s-f liquid 2-15 mg/5 ml * siltussin dm cough syrup 10-100 mg/5 ml * siltussin sa 100 mg/5 ml syr 100 mg/5 ml * sm adult nasal decongestant lq 15 mg/5 ml * (Robitussin Mucus-Chest Congest) (Robitussin) (Cough Formula Dm) (Guaifenesin/Dextr omethorphan) (Dextromethorphan Hbr) (Bromphenira/Pseu doephed/codein) (Brompheniram/Ph enylephrine/dm) (G-Zyncof) (Robitussin Mucus-Chest Congest) (Vicks Children'S Nyquil) (Cough Formula Dm) (Robitussin Mucus-Chest Congest) (Pseudoephedrine HCl) www.centersplan.com/fida/participants 114

sm childrens plus cold susp grape,multi-symptom 1-2.5-5-160 mg/5 ml * sm cold-cough child elixir 1-15-5 mg/5 ml * sm cough & runny nose liquid 1-5 mg/5 ml * sm cough-head congestion lq 20-10- 66.7 mg/5 ml * sm flu severe cold-congestion maximum strength 4-60-30-1,000 mg * sm mucus relief cough liquid childrens, a/f 5-100 mg/5 ml * sm nite time cold-flu liquid 7.5-60- 30-1,000 mg/30 ml * sm nite time cold-flu rel sfgl softgel 6.25-30-15-325 mg * sm pain reliever cold caplet 2-30- 15-325 mg * sm pedia relief liquid 1-15-5 mg/5 ml * sm severe cold m-s caplet 30-15-500 mg * sm tussin cf syrup 30-10-100 mg/5 ml * sudafed 30 mg tablet nondrowsy,max-str 30 mg * sudogest 30 mg tablet boxed 30 mg * sudogest 60 mg tablet 60 mg * suphedrin liquid 15 mg/5 ml * (Dm Hb/Pe/Acetaminop hen/chlorph) (Brompheniramine/ Pseudoephed/Dm) (Vicks Children'S Nyquil) (Trispec Pse) (Dm Hb/Pseudoephed/A cetamin/cp) (G-Zyncof) (Dm/P- Ephed/Acetaminop h/doxylam) (Dm/P- Ephed/Acetaminop h/doxylam) (Dm Hb/Pseudoephed/A cetamin/cp) (Chlorpheniramin/ Pseudoephed/Dm) (Dm/Pseudoephed/ Acetaminophen) (Guaifenesin/Dm/P seudoephedrine) (Pseudoephedrine HCl) (Pseudoephedrine HCl) (Pseudoephedrine HCl) www.centersplan.com/fida/participants 115

suphedrine pe combo pack cplt 5- (Diphenhydram/Pe/ 10-325 mg * Dm/Acetamin/Gg) THERAFLU COLD AND COUGH POWDER 10-20-650 MG * THERAFLU MULTI-SYMP COLD CPLT 5-10-325 MG * TRIAMINIC COUGH-SORE THROAT LQ A/F,CHILDREN'S 160-5 MG/5 ML * triaminic daytime cold-cough (Dextromethorphan children's, cherry 2.5-5 mg/5 ml * /Phenylephrine) tri-dex pe oral syrup 2-10-15 mg/5 (Chlorpheniramine/ ml * Phenyleph/Dm) trymine cg liquid 7.5-225 mg/5 ml * (M-Clear Wc) tusnel diabetic liquid (otc) 10-100 mg/5 ml * (G-Zyncof) TUSNEL LIQUID A/F,A/F,D/F 30-15-200 MG/5 ML * TUSNEL PEDIATRIC LIQUID (RX) 15-5-50 MG/5 ML * TUSSI PRES-B LIQUID 4-10-30 MG/5 ML * tussin cf cough & cold syrup a/f 5- (Tussi-Pres 10-100 mg/5 ml * Pediatric) tussin cold-congestion gelcap liquid (Guaifenesin/Dm/P gelcap 30-10-200 mg * seudoephedrine) tussin dm syrup 15-100 mg/5 ml * (Cough Formula Dm) VANACOF LIQUID 1-30-12.5 MG/5 ML * vicks dayquil cough liquid a/f,8 hr (Dextromethorphan rlf 5 mg/5 ml * Hbr) (Dvicks dayquil liquicaps cold & flu 5- Methorphan/Pe/Ac 10-325 mg * etaminophen) vicks nature fusion cough liq 5 mg/5 ml * (Dextromethorphan Hbr) www.centersplan.com/fida/participants 116

vicks nyquil severe cold-flu 6.25-5- (Dm/Pe/Acetamino 10-325 mg/15 ml * phen/doxylamine) virdec dm drops 1-3.5-3 mg/ml * (Chlorpheniramine/ Phenyleph/Dm) virtussin ac liquid 10-100 mg/5 ml * (M-Clear Wc) v-r infant non-asa cold drp 15-5-160 (Dm/Pseudoephed/ mg/1.6 ml * Acetaminophen) v-r non-aspirin flu gelcap gelatin (Dm/Pseudoephed/ caplet 30-15-500 mg * Acetaminophen) v-r pedia relief inf drops (Dextromethorphan decongestant + 7.5-2.5 mg/0.8 ml * /Pseudoephed) vr triacting cold-cough liq 1-15-5 (Chlorpheniramin/ mg/5 ml * Pseudoephed/Dm) v-r tussin cf syrup 30-10-100 mg/5 (Guaifenesin/Dm/P ml * seudoephedrine) wal-phed 30 mg tablet non-drowsy (Pseudoephedrine 30 mg * HCl) wal-phed pe day-night combo pk (Diphenhydram/Pe/ gluten-free 5-10-325 mg * Dm/Acetamin/Gg) wal-tussin cough & cold cf (Tussi-Pres pseudoephedrine free 5-10-100 Pediatric) mg/5 ml * wal-tussin cough 15 mg softgel 15 mg * (Robitussin) wal-tussin cough 15 mg/5 ml 15 mg/5 ml * zephrex-d 30 mg tablet 30 mg * ZONATUSS 150 MG CAPSULE 150 MG * zyncof 20-400 mg/5 ml liquid 20-400 mg/5 ml * (Dextromethorphan Hbr) (Pseudoephedrine HCl) 3 $0 (G-Zyncof) Dental And Oral Agents Dental And Oral Agents cevimeline oral capsule 30 mg (Evoxac) chlorhexidine gluconate mucous membrane mouthwash 0.12 % (Peridex) www.centersplan.com/fida/participants 117

oralone dental paste 0.1 % periogard mucous membrane mouthwash 0.12 % pilocarpine hcl oral tablet 5 mg, 7.5 mg PREVIDENT 5000 SENSITIVE DENTAL PASTE 1.1-5 % sodium fluoride oral tablet,chewable 0.25 mg fluorid (0.55 mg) triamcinolone acetonide dental paste 0.1 % (Triamcinolone Acetonide) (Peridex) (Salagen) (Sodium Fluoride) (Triamcinolone Acetonide) Dermatological Agents Dermatological Agents, Other 8-MOP ORAL CAPSULE 10 MG acitretin oral capsule 10 mg, 17.5 mg, 25 mg (Soriatane) acne medication 10% lotion 10 % * (Benzoyl Peroxide) ACNE MEDICATION 5% LOTION 5 % * acneclear gel 10 % * (Benzoyl Peroxide) acyclovir topical ointment 5 % (Zovirax) QL (30 per 30 days) ALCOHOL PADS TOPICAL PADS, MEDICATED ALCOHOL PREP PADS amlactin 12% lotion 12 % * (Ammonium Lactate) ammonium lactate 12% cream (Ammonium fragrance free (otc) 12 % * Lactate) ammonium lactate 12% lotion (otc) (Ammonium 12 % * Lactate) ammonium lactate topical cream 12 % (Lac-Hydrin) ammonium lactate topical lotion 12 % (Lac-Hydrin) www.centersplan.com/fida/participants 118

ANACAINE TOPICAL OINTMENT 10 % benzoyl peroxide 10% gel aqueous (Benzoyl Peroxide) (otc) 10 % * benzoyl peroxide 5% gel aqueous (Benzoyl Peroxide) (otc) 5 % * BETADINE 5% SPRAY 5 % * calcipotriene scalp solution 0.005 % (Calcipotriene) calcipotriene topical cream 0.005 % (Dovonex) calcipotriene topical ointment 0.005 (Calcipotriene) % calcitrene topical ointment 0.005 % (Calcipotriene) calcitriol topical ointment 3 (Vectical) mcg/gram CASTELLANI PAINT MODIFIED 1.5 % * CONDYLOX TOPICAL GEL 0.5 % COSENTYX (150 MG/ML) 300 MG DOSE-2 PENS 150 MG/ML COSENTYX (150 MG/ML) 300 MG DOSE-2 SYRINGES 150 MG/ML COSENTYX PEN SUBCUTANEOUS PEN INJECTOR 150 MG/ML COSENTYX SUBCUTANEOUS SYRINGE 150 MG/ML cvs skin treatment body lotion 12 % (Ammonium * Lactate) fluorouracil topical cream 0.5 %, 5 (Carac) % fluorouracil topical solution 2 %, 5 (Fluorouracil) % (Ammonium geri-hydrolac 12% lotion 12 % * Lactate) (Ammonium geri-hydrolac 5% lotion 5 % * Lactate) PA PA PA PA www.centersplan.com/fida/participants 119

imiquimod topical cream in packet 5 PA NSO; QL (24 per (Aldara) % 30 days) LACTINOL HX CREAM * lobana bath oil * (Mineral Oil) methoxsalen rapid oral capsule 10 mg (Oxsoralen-Ultra) PANRETIN TOPICAL GEL 0.1 % persa-gel 10% 12's,max-strength 10 % * (Benzoyl Peroxide) PICATO TOPICAL GEL 0.015 % QL (3 per 56 days) PICATO TOPICAL GEL 0.05 % QL (2 per 56 days) podocon topical liquid 25 % (Podophyllum Resin) podofilox topical solution 0.5 % (Condylox) potassium hydroxide topical (Potassium solution 5 % Hydroxide) pv acne pimple 10% gel 10 % * (Benzoyl Peroxide) SANTYL TOPICAL OINTMENT 250 UNIT/GRAM TALTZ AUTOINJECTOR PA SUBCUTANEOUS AUTO- INJECTOR 80 MG/ML TALTZ SYRINGE PA SUBCUTANEOUS SYRINGE 80 MG/ML TOLAK TOPICAL CREAM 4 % VALCHLOR TOPICAL GEL 0.016 % zenatane oral capsule 10 mg, 20 mg, (Isotretinoin) 30 mg, 40 mg zinc oxide 20% ointment 20 % * (Boudreauxs) ZOVIRAX TOPICAL CREAM 5 % QL (15 per 30 days) Dermatological Antibacterials bacitracin 500 unit/gm ointmnt 500 unit/gram * (Bacitracin) bacitraycin plus 500 unit/gm 500 unit/gram * (Bacitracin) www.centersplan.com/fida/participants 120

clindamycin phosphate topical gel 1 % clindamycin phosphate topical lotion 1 % clindamycin phosphate topical solution 1 % clindamycin phosphate topical swab 1 % cvs triple antibiotic ointment 3.5mg- 400 unit- 5,000 unit/gram * ery pads topical swab 2 % (Cleocin T) (Cleocin T) (Cleocin T) (Cleocin T) (Neomycin Su/Bacitrac Zn/Poly) (Erythromycin Base/Ethanol) erythromycin with ethanol topical gel 2 % (Emgel) erythromycin with ethanol topical (Erythromycin solution 2 % Base/Ethanol) erythromycin with ethanol topical (Erythromycin swab 2 % Base/Ethanol) gentamicin topical cream 0.1 % (Gentamicin Sulfate) gentamicin topical ointment 0.1 % (Gentamicin Sulfate) metronidazole topical cream 0.75 % (Metrocream) metronidazole topical gel 0.75 %, 1 % (Rosadan) metronidazole topical lotion 0.75 % (Metrolotion) mupirocin calcium topical cream 2 % (Bactroban) mupirocin topical ointment 2 % (Centany) neomycin-polymyxin b gu irrigation (Neosporin G.U. solution 40 mg-200,000 unit/ml Irrigant) (Neomycin neosporin ointment 3.5mg-400 unit- Su/Bacitrac 5,000 unit/gram * Zn/Poly) rosadan topical cream 0.75 % (Metrocream) selenium sulfide topical lotion 2.5 % (Selenium Sulfide) www.centersplan.com/fida/participants 121

selenium sulfide topical shampoo (Selenium Sulfide) 2.25 % silver nitrate topical ointment 10 % (Silver Nitrate) silver nitrate topical solution 0.5 %, (Silver Nitrate) 10 %, 25 %, 50 % silver sulfadiazine topical cream 1 (Silvadene) % ssd topical cream 1 % (Silvadene) sulfacetamide sodium (acne) topical (Klaron) suspension 10 % (Neomycin triple antibiotic ointment carton Su/Bacitrac 3.5mg-400 unit- 5,000 unit/gram * Zn/Poly) Dermatological Anti- Inflammatory Agents ala-cort topical cream 1 % (Anusol-HC) ala-scalp topical lotion 2 % (Scalacort) (Alclometasone alclometasone topical cream 0.05 % Dipropionate) alclometasone topical ointment 0.05 (Alclometasone % Dipropionate) aquanil hc 1% lotion 1 % * (Cortizone-10) beta hc 1% lotion 1 % * (Cortizone-10) betamethasone valerate topical (Luxiq) foam 0.12 % betamethasone valerate topical (Betamethasone betamethasone dipropionate topical betamethasone dipropionate topical betamethasone dipropionate topical betamethasone valerate topical (Betamethasone (Betamethasone (Betamethasone (Betamethasone cream 0.05 % lotion 0.05 % ointment 0.05 % cream 0.1 % Dipropionate) Dipropionate) Dipropionate) Valerate) lotion 0.1 % betamethasone valerate topical ointment 0.1 % Valerate) (Betamethasone Valerate) www.centersplan.com/fida/participants 122

betamethasone, augmented topical cream 0.05 % (Diprolene AF) betamethasone, augmented topical (Betamethasone gel 0.05 % Dipropionate) betamethasone, augmented topical lotion 0.05 % (Diprolene) betamethasone, augmented topical ointment 0.05 % (Diprolene) clobetasol 0.05% cream 0.05 % (Temovate) clobetasol scalp solution 0.05 % (Clobetasol Propionate) clobetasol topical foam 0.05 % (Olux) clobetasol topical gel 0.05 % (Clobetasol Propionate) clobetasol topical lotion 0.05 % (Clobex) clobetasol topical ointment 0.05 % (Temovate) clobetasol topical shampoo 0.05 % (Clobex) clobetasol-emollient topical cream 0.05 % (Temovate) clocortolone pivalate topical cream 0.1 % (Cloderm) colocort rectal enema 100 mg/60 ml (Cortenema) cormax scalp solution 0.05 % (Clobetasol Propionate) cortizone-10 1% creme maximum strength 1 % * (Hydrocortisone) CORTIZONE-10 1% LOTION 1 % * cortizone-10 1% ointment 1 % * (Hydrocortisone) dermarest eczema 1% lotion 1 % * (Cortizone-10) desonide topical cream 0.05 % (Desowen) desonide topical ointment 0.05 % (Desonide) desoximetasone topical cream 0.05 %, 0.25 % (Topicort) desoximetasone topical gel 0.05 % (Topicort) desoximetasone topical ointment 0.05 %, 0.25 % (Topicort) ELIDEL TOPICAL CREAM 1 % www.centersplan.com/fida/participants 123

fluocinonide 0.05% cream 0.05 % (Vanos) fluocinonide topical gel 0.05 % (Fluocinonide) fluocinonide topical ointment 0.05 % (Fluocinonide) fluocinonide topical solution 0.05 % (Fluocinonide) fluocinonide-e topical cream 0.05 % (Vanos) fluticasone topical cream 0.05 % (Cutivate) fluticasone topical ointment 0.005 % (Fluticasone Propionate) halobetasol propionate topical cream 0.05 % (Ultravate) halobetasol propionate topical ointment 0.05 % (Ultravate) hydro skin 1% lotion 1 % * (Cortizone-10) hydrocortisone 0.5% cream (otc) 0.5 % * (Hydrocortisone) hydrocortisone 0.5% ointment 0.5 % (Hydrocortisone) * hydrocortisone 1% cream maximum (Hydrocortisone) strength (otc) 1 % * hydrocortisone 1% cream maximum strength 1 % * hydrocortisone 1% lotion (otc) 1 % * hydrocortisone 1% ointment carton (otc) 1 % * hydrocortisone acet-aloe vera topical gel 2 % hydrocortisone acetate-aloe topical cream 0.5 % * hydrocortisone buty 0.1% cream 0.1 % hydrocortisone butyrate topical ointment 0.1 % hydrocortisone butyrate topical solution 0.1 % hydrocortisone butyr-emollient topical cream 0.1 % (Hydrocortisone Acetate) (Cortizone-10) 3 $0 (Hydrocortisone) (Hydrocortisone Acetate/Aloe V) (Hydrocortisone Butyrate) (Locoid) (Locoid) (Hydrocortisone Butyrate) www.centersplan.com/fida/participants 124

hydrocortisone rectal enema 100 mg/60 ml (Cortenema) hydrocortisone topical cream 1 %, 2.5 % (Anusol-HC) hydrocortisone topical ointment 1 %, 2.5 % (Hydrocortisone) hydrocortisone valerate topical (Hydrocortisone cream 0.2 % Valerate) hydrocortisone valerate topical ointment 0.2 % (Westcort) mometasone topical cream 0.1 % (Elocon) mometasone topical ointment 0.1 % (Elocon) mometasone topical solution 0.1 % (Elocon) neosporin 1% anti-itch cream 1 % * (Hydrocortisone) ONFI ORAL TABLET 10 MG, 20 MG prednicarbate topical cream 0.1 % (Dermatop) prednicarbate topical ointment 0.1 % (Dermatop) preparation h hc 1% cream 1 % * (Hydrocortisone) procto-med hc rectal cream 2.5 % (Hydrocortisone) procto-pak rectal cream 1 % (Anusol-HC) proctosol hc rectal cream 2.5 % (Hydrocortisone) proctozone-hc rectal cream 2.5 % (Hydrocortisone) recort plus 1% cream 1 % * (Hydrocortisone) tacrolimus topical ointment 0.03 %, 0.1 % (Protopic) triamcinolone acetonide topical (Triamcinolone cream 0.025 %, 0.1 %, 0.5 % Acetonide) triamcinolone acetonide topical (Triamcinolone lotion 0.025 %, 0.1 % triamcinolone acetonide topical ointment 0.025 %, 0.1 %, 0.5 % trianex topical ointment 0.05 % u-cort topical cream 1-10 % Dermatological Retinoids Acetonide) (Triamcinolone Acetonide) (Triamcinolone Acetonide) (Hydrocortisone Acetate/Urea) PA NSO; QL (60 per 30 days) www.centersplan.com/fida/participants 125

adapalene topical cream 0.1 % (Differin) adapalene topical gel 0.1 % (Differin) TAZORAC TOPICAL CREAM 0.05 %, 0.1 % tretinoin gel micro 0.04% tube 0.04 PA (Retin-A Micro) % tretinoin gel micro 0.1% tube 0.1 % (Retin-A Micro) PA tretinoin microspheres topical gel PA (Retin-A Micro) with pump 0.04 %, 0.1 % tretinoin topical cream 0.025 %, PA (Retin-A) 0.05 %, 0.1 % tretinoin topical gel 0.01 %, 0.025 (Retin-A) PA %, 0.05 % Scabicides And Pediculicides cvs lice killing shampoo maximum strength 0.33-4 % * (Piperonyl Butoxide/Pyrethrin s) cvs permethrin 1% lotion 1 % * (Nix) malathion topical lotion 0.5 % (Ovide) NIX 1% CREME RINSE LIQUID W/ NIT COMB 1 % * permethrin topical cream 5 % (Elimite) ra lice treatment 1% crm rinse 2x59ml, 2 combs 1 % * (Nix) sm lice treatment permethrin 2's 1 % * (Nix) v-r lice cream rinse 1 % * (Nix) Devices Devices ASSURE ID INSULIN SAFETY SYRINGE 1 ML 29 GAUGE X 1/2" BD INSULIN SYR 0.3 ML 31GX5/16 0.3 ML 31 GAUGE X 5/16 BD INSULIN SYR 0.5 ML 31GX5/16" 0.5 ML 31 GAUGE X 5/16 www.centersplan.com/fida/participants 126

BD INSULIN SYR 1 ML 31GX5/16" 1 ML 31 GAUGE X 5/16 BD ULTRA-FINE PEN NDL 8MMX31G SHORT 31 GAUGE X 5/16" INSULIN SYRINGE-NEEDLE U- 100 SYRINGE 0.3 ML 29, 1 ML 29 GAUGE X 1/2", 1/2 ML 28 GAUGE PEN NEEDLE, DIABETIC NEEDLE 29 GAUGE X 1/2 " VGO 40 DISPOSABLE DEVICE Disinfectants (For Non- Dermatologic Use) Disinfectants (For Non- Dermatologic Use) sm iodine tincture * (Iodine) Enzyme Replacement/Modifiers Enzyme Replacement/Modifiers ADAGEN INTRAMUSCULAR SOLUTION 250 UNIT/ML ALDURAZYME INTRAVENOUS SOLUTION 2.9 MG/5 ML CEREZYME INTRAVENOUS RECON SOLN 400 UNIT CREON ORAL CAPSULE,DELAYED RELEASE(DR/EC) 12,000-38,000-60,000 UNIT, 24,000-76,000-120,000 UNIT, 3,000-9,500-15,000 UNIT, 36,000-114,000-180,000 UNIT, 6,000-19,000-30,000 UNIT ELAPRASE INTRAVENOUS SOLUTION 6 MG/3 ML www.centersplan.com/fida/participants 127

ELITEK INTRAVENOUS RECON SOLN 1.5 MG FABRAZYME INTRAVENOUS RECON SOLN 35 MG KANUMA INTRAVENOUS SOLUTION 2 MG/ML KRYSTEXXA INTRAVENOUS SOLUTION 8 MG/ML KUVAN ORAL TABLET,SOLUBLE 100 MG MYOZYME INTRAVENOUS RECON SOLN 50 MG NAGLAZYME INTRAVENOUS SOLUTION 5 MG/5 ML ORFADIN ORAL CAPSULE 10 MG, 2 MG, 5 MG pancrelipase 5000 oral capsule,delayed release(dr/ec) 5,000-17,000-27,000 unit PULMOZYME INHALATION SOLUTION 1 MG/ML STRENSIQ SUBCUTANEOUS SOLUTION 100 MG/ML, 40 MG/ML VIMIZIM INTRAVENOUS SOLUTION 5 MG/5 ML (1 MG/ML) VPRIV INTRAVENOUS RECON SOLN 400 UNIT ZAVESCA ORAL CAPSULE 100 MG (Lipase/Protease/A mylase) PA PA; LA PA QL (90 per 30 days) www.centersplan.com/fida/participants 128

ZENPEP ORAL CAPSULE,DELAYED RELEASE(DR/EC) 10,000-34,000-55,000 UNIT, 15,000-51,000-82,000 UNIT, 20,000-68,000-109,000 UNIT, 25,000-85,000-136,000 UNIT, 3,000-10,000-16,000 UNIT, 40,000-136,000-218,000 UNIT, 5,000-17,000-27,000 UNIT Eye, Ear, Nose, Throat Agents Eye, Ear, Nose, Throat Agents, Miscellaneous AKTEN (PF) OPHTHALMIC GEL 3.5 % alcaine ophthalmic drops 0.5 % (Proparacaine HCl) altacaine ophthalmic drops 0.5 % (Tetravisc) altamist 0.65% nose spray 0.65 % * (Little Remedies) apraclonidine ophthalmic drops 0.5 % (Iopidine) artificial tears 1.4 % drops 1.4 % * (Polyvinyl Alcohol) (Dextran artificial tears drops p/f, sterile 0.1-70/Hypromellose/P 0.3 % * F) artificial tears eye drops strl 0.1-0.3 % * (Tears Naturale) artificial tears eye ointment 83-15 % (Genteal Pm) * atropine ophthalmic drops 1 % (Isopto Atropine) atropine ophthalmic ointment 1 % (Atropine Sulfate) atropine-care ophthalmic drops 1 % (Isopto Atropine) ayr saline 0.65% nose drops 0.65 % * (Sodium Chloride) ayr saline 0.65% nose spray 0.65 % * (Little Remedies) azelastine nasal aerosol,spray 137 mcg (0.1 %) (Astepro) QL (30 per 25 days) www.centersplan.com/fida/participants 129

azelastine ophthalmic drops 0.05 % (Azelastine HCl) (Dextran bion tears eye drops 0.1-0.3 % * 70/Hypromellose/P F) carteolol ophthalmic drops 1 % (Carteolol HCl) (Cromolyn cromolyn ophthalmic drops 4 % Sodium) cvs artificial tears drops sterile 1- (Glycerin/Propylen 0.3 % * e Glycol) cvs lubricant 0.5% eye drops sterile (Refresh Tears) 0.5 % * (Carboxymethylcel cvs lubricant dry eye rlf 1% 1 % * lulose Sodium) cvs lubricant eye ointment p/f 57.3- (Genteal Pm) 42.5 % * cvs lubricant gel eye drops 0.25-0.3 (Carboxymethylcel % * l/hypromellose) cvs lubricating eye drops dry eye (Refresh Optive) soln 0.5-0.9 % * (Dextran cvs natural tears drops 0.1-0.3 % * 70/Hypromellose/P F) cyclopentolate ophthalmic drops 0.5 (Cyclogyl) %, 1 %, 2 % CYSTARAN OPHTHALMIC DROPS 0.44 % deep sea 0.65% nose spray 0.65 % * (Little Remedies) (Oxymetazoline dristan long lasting mist 0.05 % * HCl) epinastine ophthalmic drops 0.05 % (Elestat) (Genteal Mild To eq gentle 0.3% eye drops 0.3 % * Moderate) eq revive plus 0.5% eye drops 0.5 % (Carboxymethylcel * lulose Sodium) flucaine ophthalmic drops 0.25-0.5 (Proparacaine/Fluo % rescein Sod) GENTEAL GEL DROPS 0.25-0.3 % * www.centersplan.com/fida/participants 130

GENTEAL MILD 0.2% EYE DROPS 0.2 % * GENTEAL MILD-MODERATE EYE DROP P/F, DRY EYE RELIEF 0.3 % * GENTEAL SEVERE 0.3% EYE GEL P/F, STRL, INNER 0.3 % * genteal tears 0.1%-0.3% drop 0.1-0.3 % * (Tears Naturale) homatropaire ophthalmic drops 5 % (Isopto Homatropine) homatropine hbr ophthalmic drops (Isopto 5 % Homatropine) ipratropium bromide nasal spray,non-aerosol 0.03 % (Atrovent) ipratropium bromide nasal spray,non-aerosol 0.06 % (Atrovent) isopto tears 0.5% eye drops 0.5 % * (Genteal Mild To Moderate) LACRISERT OPHTHALMIC INSERT 5 MG lubricant 0.5-0.9% eye drops 0.5- (Carboxymethylcel 0.9 % * l/glycerin/pf) lubricant 0.5-0.9% eye drops 0.5-0.9 % * (Refresh Optive) lubricant 0.6% eye drops 0.6 % * (Propylene Glycol) lubrifresh pm eye ointment 83-15 % * (Genteal Pm) muro-128 2% eye drops 2 % * (Sodium Chloride) muro-128 5% eye drops 5 % * (Sodium Chloride) muro-128 5% eye ointment 5 % * (Sodium Chloride) naphazoline ophthalmic drops 0.1 % (Naphazoline HCl) nasal decongestant 0.05% spray 0.05 % * (Afrin) natural balance tears drops 0.4 % * (Genteal Mild To Moderate) nature's tears drops 0.4 % * (Genteal Mild To Moderate) QL (30 per 28 days) QL (15 per 10 days) www.centersplan.com/fida/participants 131

neo-synephrine 12 hour spray 0.05 (Oxymetazoline % * HCl) ocean 0.65% nasal spray 0.65 % * (Little Remedies) olopatadine ophthalmic drops 0.1 % (Patanol) PATADAY OPHTHALMIC DROPS 0.2 % phenylephrine hcl ophthalmic drops (Mydfrin) 10 %, 2.5 % proparacaine ophthalmic drops 0.5 (Proparacaine HCl) % pure & gentle eye drops lubricant (Genteal Mild To 0.3 % * Moderate) (Genteal Mild To pv artificial tears 0.4 % * Moderate) pv lubricant 1.4 % eye drops 1.4 % (Polyvinyl * Alcohol) REFRESH CELLUVISC 1% EYE DROPS 1 % * REFRESH CLASSIC EYE DROPS U-D,P/F,30X.4ML 1.4-0.6 % * REFRESH LACRI-LUBE OINTMENT 56.8-42.5 % * REFRESH OPTIVE EYE DROPS 0.5-0.9 % * (Carboxymethylcel retaine cmc 0.5% eye drops 0.5 % * lulose Sodium) saline mist 0.65% nose spry 0.65 % (Little Remedies) * sea soft 0.65% nasal mist 0.65 % * (Little Remedies) sm lubricant eye drops strl 0.4-0.3 (Systane) % * sodium chloride 5% eye drop 5 % * (Sodium Chloride) sodium chloride 5% eye oint 5 % * (Sodium Chloride) SYSTANE 0.3-0.4% EYE DROPS 0.4-0.3 % * pv pure-gentle eye drops sterile 0.3 (Genteal Mild To % * Moderate) ST www.centersplan.com/fida/participants 132

SYSTANE GEL EYE DROPS 0.4-0.3 % * tears again 1.4 % drops 1.4 % * (Polyvinyl Alcohol) tears again eye ointment 80-20 % * (Genteal Pm) (Dextran tears naturale free drops u- 70/Hypromellose/P d,36x.9ml,p/f 0.1-0.3 % * F) tetracaine hcl (pf) ophthalmic drops (Tetracaine 0.5 % HCl/PF) ultra fresh pm ointment * (Lanolin/Min Oil/Petrolat, Wht) vicks qlearquil 0.05% mist 0.05 % * (Oxymetazoline HCl) vicks sinex 12 hour spray 0.05 % * (Afrin) Eye, Ear, Nose, Throat Anti-Infectives Agents acetic acid otic solution 2 % (Acetic Acid) bacitracin ophthalmic ointment 500 unit/gram (Bacitracin) bacitracin-polymyxin b ophthalmic (Bacitracin/Polymy ointment 500-10,000 unit/gram xin B Sulfate) bleph-10 ophthalmic drops 10 % (Sulfacetamide Sodium) CIPRODEX OTIC DROPS,SUSPENSION 0.3-0.1 % ciprofloxacin hcl ophthalmic drops 0.3 % (Ciloxan) ciprofloxacin hcl otic dropperette 0.2 % (Cetraxal) COLY-MYCIN S OTIC DROPS,SUSPENSION 3.3-3-10-0.5 MG/ML erythromycin ophthalmic ointment 5 mg/gram (0.5 %) (Ilotycin) gatifloxacin ophthalmic drops 0.5 % (Zymaxid) gentak ophthalmic ointment 0.3 % (3 mg/gram) (Garamycin) www.centersplan.com/fida/participants 133

gentamicin ophthalmic drops 0.3 % (Garamycin) gentamicin ophthalmic ointment 0.3 % (3 mg/gram) (Garamycin) levofloxacin ophthalmic drops 0.5 % (Levofloxacin) MOXEZA OPHTHALMIC DROPS, VISCOUS 0.5 % NATACYN OPHTHALMIC DROPS,SUSPENSION 5 % neomycin-bacitracin-poly-hc (Neomycin Su/Baci ophthalmic ointment 3.5-400-10,000 Zn/Poly/HC) mg-unit/g-1% neomycin-bacitracin-polymyxin ophthalmic ointment 3.5-400-10,000 mg-unit-unit/g neomycin-polymyxin b-dexameth ophthalmic drops,suspension 3.5mg/ml-10,000 unit/ml-0.1 % neomycin-polymyxin b-dexameth ophthalmic ointment 3.5 mg/g- 10,000 unit/g-0.1 % neomycin-polymyxin-gramicidin ophthalmic drops 1.75 mg-10,000 unit-0.025mg/ml neomycin-polymyxin-hc ophthalmic drops,suspension 3.5-10,000-10 mgunit-mg/ml neomycin-polymyxin-hc otic drops,suspension 3.5-10,000-1 mg/ml-unit/ml-% (Neomycin Su/Bacitra/Polymy xin) (Maxitrol) (Maxitrol) (Neosporin) (Neomycin/Polymy xin B Sulf/HC) (Neomycin/Polymy xin B Sulf/HC) neomycin-polymyxin-hc otic solution 3.5-10,000-1 mg/mlunit/ml-% (Cortisporin) neo-polycin hc ophthalmic ointment (Neomycin Su/Baci 3.5-400-10,000 mg-unit/g-1% Zn/Poly/HC) (Neomycin neo-polycin ophthalmic ointment Su/Bacitra/Polymy 3.5-400-10,000 mg-unit-unit/g xin) ofloxacin ophthalmic drops 0.3 % (Ocuflox) www.centersplan.com/fida/participants 134

ofloxacin otic drops 0.3 % (Ocuflox) polymyxin b sulf-trimethoprim ophthalmic drops 10,000 unit- 1 (Polytrim) mg/ml REFRESH OPTIVE ADVANCED DROPS 0.5-1-0.5 % * sulfacetamide sodium ophthalmic (Sulfacetamide drops 10 % Sodium) sulfacetamide sodium ophthalmic (Sulfacetamide ointment 10 % Sodium) sulfacetamide-prednisolone (Sulfacetamide/Pre ophthalmic drops 10 %-0.23 % dnisolone Sp) (0.25 %) TOBRADEX OPHTHALMIC OINTMENT 0.3-0.1 % TOBRADEX ST OPHTHALMIC DROPS,SUSPENSION 0.3-0.05 % tobramycin ophthalmic drops 0.3 % (Tobrex) tobramycin-dexamethasone ophthalmic drops,suspension 0.3-0.1 (Tobradex) % trifluridine ophthalmic drops 1 % (Viroptic) VIGAMOX OPHTHALMIC DROPS 0.5 % ZIRGAN OPHTHALMIC GEL 0.15 % ZYLET OPHTHALMIC DROPS,SUSPENSION 0.3-0.5 % Eye, Ear, Nose, Throat Anti-Inflammatory Agents ALREX OPHTHALMIC DROPS,SUSPENSION 0.2 % bromfenac ophthalmic drops 0.09 % (Bromfenac Sodium) dexamethasone sodium phosphate (Dexasol) ophthalmic drops 0.1 % diclofenac sodium ophthalmic drops 0.1 % (Diclofenac Sodium) ST www.centersplan.com/fida/participants 135

DUREZOL OPHTHALMIC DROPS 0.05 % flunisolide nasal spray,non-aerosol 25 mcg (0.025 %) fluorometholone ophthalmic drops,suspension 0.1 % flurbiprofen sodium ophthalmic drops 0.03 % fluticasone nasal spray,suspension 50 mcg/actuation ILEVRO OPHTHALMIC DROPS,SUSPENSION 0.3 % ketorolac ophthalmic drops 0.4 %, 0.5 % LOTEMAX OPHTHALMIC DROPS,GEL 0.5 % LOTEMAX OPHTHALMIC DROPS,SUSPENSION 0.5 % LOTEMAX OPHTHALMIC OINTMENT 0.5 % NEVANAC OPHTHALMIC DROPS,SUSPENSION 0.1 % prednisolone acetate ophthalmic drops,suspension 1 % prednisolone sodium phosphate ophthalmic drops 1 % PROLENSA OPHTHALMIC DROPS 0.07 % RESTASIS OPHTHALMIC DROPPERETTE 0.05 % Gastrointestinal Agents Antiflatulents bicarsim forte 125 mg tablet 125 mg * cvs gas relief 125 mg chew tab extra strength 125 mg * cvs gas relief 125 mg softgel softgel 125 mg * (Flunisolide) (FML) (Ocufen) (Fluticasone Propionate) (Acular) (Omnipred) (Prednisolone Sod Phosphate) (Simethicone) (Gas-X) (Phazyme) QL (50 per 25 days) QL (60 per 30 days) www.centersplan.com/fida/participants 136

cvs gas relief 80 mg tab chew 80 mg * (Gas-X) gas relief 125 mg chew tablet max str,lactose-free 125 mg * (Gas-X) gas relief 80 mg tablet chew lactosefree 80 mg * (Gas-X) gas-x ultra strength softgel 180 mg * (Phazyme) mi-acid gas 80 mg tab chew 80 mg * (Gas-X) mytab gas 80 mg tablet chew 80 mg * (Gas-X) mytab gas max str 125 mg tab 125 mg * (Gas-X) simethicone 180 mg softgel 180 mg * (Phazyme) simethicone 40 mg/0.6 ml drop 40 mg/0.6 ml * (Simethicone) v-r anti-gas 166 mg softgel 166 mg * (Phazyme) Antiulcer Agents And Acid Suppressants acid reducer 20 mg tablet maximum strength 20 mg * (Pepcid Ac) amoxicil-clarithromy-lansopraz oral (Prevpac) combo pack 500-500-30 mg CARAFATE ORAL SUSPENSION 100 MG/ML cimetidine hcl oral solution 300 mg/5 ml (Cimetidine HCl) cimetidine oral tablet 200 mg, 300 mg, 400 mg, 800 mg (Cimetidine) cvs cimetidine 200 mg tablet (otc) 200 mg * (Tagamet Hb) esomeprazole sodium intravenous recon soln 20 mg, 40 mg (Nexium I.V.) famotidine (pf) intravenous solution 20 mg/2 ml (Famotidine) (Rx Product Only) www.centersplan.com/fida/participants 137

famotidine (pf)-nacl (iso-os) (Famotidine In intravenous piggyback 20 mg/50 ml Nacl,Iso-Osm/PF) famotidine 40 mg/4 ml vial 25's,outer 10 mg/ml (Famotidine) famotidine oral tablet 20 mg, 40 mg (Pepcid) (Rx Product Only) gnp acid reducer 10 mg tablet 10 mg * (Pepcid Ac) lansoprazole dr 15 mg capsule na/f (otc) 15 mg * (Prevacid 24hr) lansoprazole oral capsule,delayed (Rx Product Only) (Prevacid) release(dr/ec) 15 mg, 30 mg misoprostol oral tablet 100 mcg, 200 mcg (Cytotec) omeprazole dr 20 mg tablet 20 mg * (Omeprazole) omeprazole mag dr 20.6 mg cap two (Omeprazole 14-days course 20 mg * Magnesium) omeprazole oral capsule,delayed release(dr/ec) 10 mg, 20 mg, 40 mg (Prilosec) omeprazole-sodium bicarbonate (Rx Product Only) (Zegerid) oral capsule 20-1.1 mg-gram pantoprazole oral tablet,delayed release (dr/ec) 20 mg, 40 mg (Protonix) PRILOSEC OTC 20.6 MG TABLET OTC 20 MG * pub famotidine 20 mg tablet max strength (otc) 20 mg * (Pepcid Ac) pv acid relief 200 mg tablet 200 mg * (Tagamet Hb) ra omeprazole-bicarb 20-1,100 3x14 day course (otc) 20-1.1 mggram (Zegerid Otc) * ranitidine 150 mg tablet maximum strength (otc) 150 mg * (Zantac) ranitidine 75 mg tablet s/f, sodiumfree 75 mg * (Zantac) ranitidine hcl 50 mg/2 ml vial sdv 50 (Rx Product Only) (Zantac) mg/2 ml (25 mg/ml) www.centersplan.com/fida/participants 138

ranitidine hcl injection solution 25 (Rx Product Only) (Zantac) mg/ml ranitidine hcl oral capsule 150 mg, (Rx Product Only) (Ranitidine HCl) 300 mg ranitidine hcl oral syrup 15 mg/ml (Ranitidine HCl) (Rx Product Only) ranitidine hcl oral tablet 150 mg, (Rx Product Only) (Zantac) 300 mg sucralfate oral suspension 100 mg/ml (Sucralfate) sucralfate oral tablet 1 gram (Carafate) wal-zan 75 mg tablet 75 mg * (Zantac) ZANTAC 150 MG TABLET TWIN PACK(2X45TABS) (OTC) 150 MG * ZANTAC 150 MG TABLET TWIN PK, MAX STRGTH (OTC) 150 MG * ZANTAC 75 MG TABLET 75 MG * Gastrointestinal Agents, Other acid gone antacid liquid 95-358 mg/15 ml * (Gaviscon) almacone liquid 200-200-20 mg/5 (Maalox Maximum ml * Strength) almacone-2 liquid 400-400-40 mg/5 (Maalox Maximum ml * aluminum hydroxide gel sugar-free 320 mg/5 ml * AMITIZA ORAL CAPSULE 24 MCG, 8 MCG antacid plus x-stren susp 500-450- 40 mg/5 ml * antacid ultra tablet chew 400 mg (1,000 mg) * antacid xtra strength chew tab extra-strength 300 mg (750 mg) * Strength) (Aluminum Hydroxide) (Maalox Maximum Strength) (Tums) (Tums) QL (60 per 30 days) www.centersplan.com/fida/participants 139

antacid-antigas liquid 200-200-20 mg/5 ml * anti-diarrheal 2 mg caplet caplet 2 mg * bismatrol suspension 262 mg/15 ml * BUPHENYL ORAL TABLET 500 MG calci-chew tablet 500 mg calcium (1,250 mg) * calcium 500 mg chewable tablet tab chew,p/f 500 mg calcium (1,250 mg) * calcium antacid 500 mg chw tab assorted fruit 200 mg calcium (500 mg) * CALCIUM-500 MG TABLET CHEWABLE SOY FREE, YEAST FREE 500-100 MG-UNIT * cal-gest 500 mg tablet chew 200 mg calcium (500 mg) * CARBAGLU ORAL TABLET, DISPERSIBLE 200 MG child soothe 400 mg tab chew 400 mg * children pepto 400 mg tab chew bubble gum, na/f 400 mg * comfort gel max str susp max-str 400-400-40 mg/5 ml * comfort gel suspension regular str, cherry 200-200-20 mg/5 ml * constulose oral solution 10 gram/15 ml cromolyn oral concentrate 100 mg/5 ml cvs antacid-antigas tab chew 1,000-60 mg * (Maalox Maximum Strength) (Imodium A-D) (Pepto-Bismol) (Tums) (Tums) (Tums) (Tums) (Tums) (Tums) (Maalox Maximum Strength) (Maalox Maximum Strength) (Lactulose) (Gastrocrom) (Calcium Carbonate/Simethi cone) www.centersplan.com/fida/participants 140

cvs anti-diarrheal 2 mg sftgel softgel (Loperamide HCl) 2 mg * cvs anti-diarrheal suspension 262 mg/15 ml * (Pepto-Bismol) cvs loperamide 1 mg/7.5 ml liq mint 1 mg/7.5 ml * (Loperamide HCl) diamode 2 mg tablet outer, f/c 2 mg * (Imodium A-D) dicyclomine oral capsule 10 mg (Bentyl) dicyclomine oral solution 10 mg/5 ml (Dicyclomine HCl) dicyclomine oral tablet 20 mg (Bentyl) digestive relief 262 mg chw tb 262 (Pepto-Bismol Tomg * Go) diphenoxylate-atropine oral liquid (Diphenoxylate 2.5-0.025 mg/5 ml HCl/Atropine) diphenoxylate-atropine oral tablet 2.5-0.025 mg (Lomotil) enulose oral solution 10 gram/15 ml (Lactulose) flanax antacid liquid 200-200-20 (Maalox Maximum mg/5 ml * Strength) foaming antacid liquid 95-358 mg/15 ml * (Gaviscon) GATTEX 5 MG 30-VIAL KIT 5 MG GATTEX ONE-VIAL SUBCUTANEOUS KIT 5 MG gelusil antacid & antigas liq 400- (Maalox Maximum 400-40 mg/5 ml * Strength) gelusil tablet chewable cool mint 200-200-25 mg * (Almacone) generlac oral solution 10 gram/15 ml (Lactulose) glycopyrrolate injection solution 0.2 mg/ml (Robinul) glycopyrrolate oral tablet 1 mg, 2 mg (Robinul) PA PA www.centersplan.com/fida/participants 141

imodium a-d 1 mg/7.5 ml liquid mint 1 mg/7.5 ml * IMODIUM A-D 2 MG CAPLET CAPLET 2 MG * kaopectate 262 mg/15 ml susp vanilla flavor 262 mg/15 ml * kionex 15 gm/60 ml suspension 15 gram/60 ml kionex oral powder (Loperamide HCl) (Pepto-Bismol) (Sodium Polystyrene Sulfonate) (Sodium Polystyrene Sulfonate) lactulose oral solution 10 gram/15 ml (Lactulose) LINZESS ORAL CAPSULE 145 MCG, 290 MCG loperamide 1 mg/5 ml liquid 1 mg/5 ml * (Loperamide HCl) loperamide oral capsule 2 mg (Loperamide HCl) LOTRONEX ORAL TABLET 0.5 MG, 1 MG maalox advanced suspension (Maalox Maximum regular strength 200-200-20 mg/5 Strength) ml * MAGNEBIND 300 TABLET 250-300 MG * magnesium 500 mg capsule s/f,na/f 500 mg * magnesium oxide 250 mg tablet 250 mg * magnesium oxide 400 mg tablet 400 mg * magnesium oxide 500 mg tablet p/f,s/f,lactose-free 500 mg * masanti liquid 400-400-40 mg/5 ml * medi-first pep-t-med tab chew 262 mg * (Uromag) (Magox 400) (Magox 400) (Magox 400) (Maalox Maximum Strength) (Pepto-Bismol To- Go) QL (30 per 30 days) www.centersplan.com/fida/participants 142

methscopolamine oral tablet 2.5 mg, (Methscopolamine 5 mg Bromide) metoclopramide hcl injection (Metoclopramide solution 5 mg/ml HCl) metoclopramide hcl oral solution 5 (Metoclopramide mg/5 ml HCl) metoclopramide hcl oral tablet 10 mg, 5 mg (Reglan) mgo 400 mg tablet 400 mg * (Magox 400) mi acid suspension 200-200-20 (Maalox Maximum mg/5 ml, 400-400-40 mg/5 ml * Strength) mi-acid ds tablet 700-300 mg * (Rolaids) mintox maximum strength susp max (Maalox Maximum str, lemon creme 400-400-40 mg/5 Strength) ml * mintox plus tablet chewable 200-200-25 mg * (Almacone) mintox suspension mint creme 200- (Maalox Maximum 200-20 mg/5 ml * Strength) MOVANTIK ORAL TABLET 12.5 MG, 25 MG NUTRESTORE ORAL POWDER IN PACKET 5 GRAM phillips 500 mg caplet 500 mg * (Magox 400) pink bismuth tablet chew 262 mg * (Pepto-Bismol To- Go) ra loperamide 1 mg/7.5 ml susp mint (Loperamide HCl) 1 mg/7.5 ml * ra magnesium 500 mg capsule 500 mg * (Uromag) RAVICTI ORAL LIQUID 1.1 GRAM/ML RELISTOR SUBCUTANEOUS SOLUTION 12 MG/0.6 ML RELISTOR SUBCUTANEOUS SYRINGE 12 MG/0.6 ML, 8 MG/0.4 ML QL (30 per 30 days) PA PA; QL (28 per 28 days) PA; QL (28 per 28 days) www.centersplan.com/fida/participants 143

ri-gel ii suspension 400-400-40 mg/5 ml * ri-mox suspension 200-200-20 mg/5 ml * sm foaming antacid tablet chew 80-20 mg * sm stomach relief caplet 262 mg * sodium bicarb 650 mg tablet 10 gr 650 mg * sodium polystyrene (sorb free) oral suspension 15 gram/60 ml sodium polystyrene sulfonate rectal enema 30 gram/120 ml soothe 262 mg caplet caplet 262 mg * soothe 262 mg/15 ml suspension s/f,cherry 262 mg/15 ml * sps 15 gm/60 ml suspension 15 gram/60 ml (Maalox Maximum Strength) (Maalox Maximum Strength) (Gaviscon) (Bismuth Subsalicylate) (Sodium Bicarbonate) (Sodium Polystyrene Sulfonate) (Sodium Polystyrene Sulfonate) (Bismuth Subsalicylate) (Pepto-Bismol) (Sodium Polystyrene Sulfonate) ursodiol oral capsule 300 mg (Actigall) ursodiol oral tablet 250 mg, 500 mg (Urso) VIBERZI ORAL TABLET 100 MG, 75 MG Laxatives alophen pills 5 mg * (Dulcolax) bisac-evac 10 mg suppository 10 mg * (Dulcolax) bisacodyl 10 mg suppository 10 mg * (Dulcolax) bisacodyl ec 5 mg tablet 5 mg * (Dulcolax) biscolax 10 mg suppository 10 mg * (Dulcolax) BLADDER CONTROL PAD X- LONG 9'S,X-LONG * ST; QL (60 per 30 days) www.centersplan.com/fida/participants 144

COLACE 100 MG CAPSULE 100 MG * cvs enema disposable 19-7 gram/118 ml * (Enema) cvs fiber therapy 500 mg caplt soluble, caplet 500 mg * (Citrucel) cvs kids 100 mg mini enema 100 mg/5 ml * (Docusate Sodium) cvs purelax powder 14 once-daily doses 17 gram/dose * (Gavilax) cvs purelax powder packet s/f, 10 daily doses 17 gram * cvs senna laxative 8.6 mg tab 8.6 mg (Senokot) * cvs stool softener softgel softgel 240 mg * (Surfak) doc-q-lace 100 mg softgel 100 mg * (Colace) docu liquid 50 mg/5 ml 50 mg/5 ml * (Docusate Sodium) docusate sodium 100 mg tablet crushable 100 mg * (Docusate Sodium) docusate sodium-senna tablet 8.6-50 (Sennosides/Docus mg * ate Sodium) docusol mini-enema outer 283 mg * (Docusate Sodium) dok 100 mg softgel softgel 100 mg * (Colace) dok 100 mg tablet 100 mg * (Docusate Sodium) dulcolax ss 100 mg softgel 100 mg * (Colace) enema disposable 19-7 gram/118 ml * (Enema) enema ready to use latex-free 19-7 gram/118 ml * (Enema) enemeez mini enema 5cc tubes, outer 283 mg/5 ml * (Docusate Sodium) enemeez plus mini enema outer 283-20 mg/5 ml * (Docusol Plus) eq fiber therapy powder * (Psyllium Seed (With Sugar)) www.centersplan.com/fida/participants 145

equalactin 500 mg tab chew 500 mg (Calcium * Polycarbophil) fiber tablet unboxed 625 mg * (Fibercon) fiber therapy powder 2 gram/19 (Citrucel) gram * fiber-lax captabs 500mg (Fibercon) polycarbophil 625 mg * fibertab oral tablet 625 mg * (Fibercon) FLEET BISACODYL 10 MG ENEMA 10 MG/30 ML * gavilyte-c oral recon soln 240- (Golytely) 22.72-6.72-5.84 gram gavilyte-g oral recon soln 236- (Golytely) 22.74-6.74-5.86 gram (Nulytely with gavilyte-n oral recon soln 420 gram Flavor Packs) gentlelax powder 30 once-daily (Gavilax) doses 17 gram/dose * glycolax powder 7 doses (otc) 17 (Gavilax) 3 $0 gram/dose * healthylax powder packet 14x17gm, (Miralax) outer 17 gram * hydrocil instant packet * (Psyllium Seed) KONSYL 6 GM PACKET S/F, GLUTEN-F, OUTER 6 GRAM * konsyl fiber 625 mg caplet caplet, s/f (Fibercon) 625 mg * magic bullet 10 mg suppos 10 mg * (Dulcolax) mineral oil laxative * (Mineral Oil) MOVIPREP ORAL POWDER IN PACKET 100-7.5-2.691 GRAM (Psyllium Seed natural fiber lax powder * (With Sugar)) konsyl psyllium fiber packet orange, milk of magnesia suspension 400 (Psyllium Husk (Milk Of gluten free 3.4 gram * mg/5 ml * (With Sugar)) Magnesia) www.centersplan.com/fida/participants 146

oral saline laxative liquid s/f, ginger (Na Phos,M-B/Na lemon 7.2-2.7 gram/15 ml * Phos,Di-Ba) peg 3350-electrolytes oral recon soln 236-22.74-6.74-5.86 gram, 240-22.72-6.72-5.84 gram (Golytely) peg-electrolyte soln oral recon soln (Nulytely with 420 gram Flavor Packs) peri-colace tablet 8.6-50 mg * (Sennosides/Docus ate Sodium) phillips' lax liqui-gels 100 mg * (Colace) phosphate oral saline laxative s/f, (Na Phos,M-B/Na ginger lemon 7.2-2.7 gram/15 ml * Phos,Di-Ba) polyethylene glycol 3350 oral (Polyethylene powder 17 gram/dose Glycol 3350) polyethylene glycol 3350 oral (Polyethylene powder in packet 17 gram Glycol 3350) polyethylene glycol 3350 powd 14 once-daily doses (otc) 17 gram/dose (Gavilax) * polyethylene glycol 3350 powd 17 grams pkts,outer (otc) 17 gram * (Miralax) polyethylene glycol 3350 powd outer,s/f (otc) 17 gram * (Miralax) promolaxin 100 mg tablet 100 mg * (Docusate Sodium) pv senna 8.6 mg softgel 8.6 mg * (Sennosides) ra enema twin pack 2 x 4.5oz, rtu 19-7 gram/118 ml * (Enema) ra laxative peg 3350 powder 14 once-daily doses 17 gram/dose * (Gavilax) reguloid powder orange * (Psyllium Seed (With Sugar)) senexon 8.8 mg/5 ml liquid 8.8 mg/5 ml * (Sennosides) senexon tablet 8.6 mg * (Senokot) senna 8.8 mg/5 ml syrup a/f, chocolate 8.8 mg/5 ml * (Sennosides) senna-lax 8.6 mg tablet 8.6 mg * (Senokot) www.centersplan.com/fida/participants 147

senokot-s tablet 8.6-50 mg * (Sennosides/Docus ate Sodium) silace 50 mg/5 ml liquid 50 mg/5 ml * (Docusate Sodium) silace 60 mg/15 ml syrup 60 mg/15 ml * (Docusate Sodium) sm clearlax powder 14 once-daily doses 17 gram/dose * (Gavilax) sm fiber laxative 500 mg cplt 500 mg * (Citrucel) sm fiber smooth powder * (Psyllium Seed) smoothlax powder packet 10 oncedaily doses 17 gram * (Miralax) trilyte with flavor packets oral recon (Nulytely with soln 420 gram Flavor Packs) Phosphate Binders calcium acetate oral capsule 667 mg (Phoslo) calcium acetate oral tablet 667 mg (Calcium Acetate) calphron 667 mg tablet 667 mg * (Calcium Acetate) eliphos oral tablet 667 mg (Calcium Acetate) (Calcium magnebind 400 oral tablet 400-200- Carbonate/Mag 1 mg Carb/Fa) PHOSLYRA ORAL SOLUTION 667 MG (169 MG CALCIUM)/5 ML RENAGEL ORAL TABLET 400 MG, 800 MG RENVELA ORAL POWDER IN PACKET 0.8 GRAM, 2.4 GRAM RENVELA ORAL TABLET 800 MG Genitourinary Agents Antispasmodics, Urinary MYRBETRIQ ORAL TABLET EXTENDED RELEASE 24 HR 25 MG, 50 MG www.centersplan.com/fida/participants 148

oxybutynin chloride oral syrup 5 (Oxybutynin mg/5 ml Chloride) oxybutynin chloride oral tablet 5 mg (Oxybutynin Chloride) oxybutynin chloride oral tablet extended release 24hr 10 mg, 15 (Ditropan XL) mg, 5 mg tolterodine oral capsule,extended release 24hr 2 mg, 4 mg (Detrol LA) tolterodine oral tablet 1 mg, 2 mg (Detrol) TOVIAZ ORAL TABLET EXTENDED RELEASE 24 HR 4 MG, 8 MG trospium oral capsule,extended (Trospium release 24hr 60 mg Chloride) trospium oral tablet 20 mg (Trospium Chloride) Genitourinary Agents, Miscellaneous alfuzosin oral tablet extended release 24 hr 10 mg (Uroxatral) tamsulosin oral capsule,extended release 24hr 0.4 mg (Flomax) terazosin oral capsule 1 mg, 10 mg, 2 mg, 5 mg (Terazosin HCl) Heavy Metal Antagonists Heavy Metal Antagonists deferoxamine injection recon soln 2 gram, 500 mg DEPEN TITRATABS ORAL TABLET 250 MG EXJADE ORAL TABLET, DISPERSIBLE 125 MG, 250 MG, 500 MG FERRIPROX ORAL SOLUTION 100 MG/ML FERRIPROX ORAL TABLET 500 MG (Desferal) www.centersplan.com/fida/participants 149

sodium thiosulfate intravenous solution 1 gram/10 ml (100 mg/ml), 12.5 gram/50 ml (250 mg/ml) SYPRINE ORAL CAPSULE 250 MG Hormonal Agents, Stimulant/Replacement/Modif ying Androgens ANDRODERM TRANSDERMAL PATCH 24 HOUR 2 MG/24 HOUR, 4 MG/24 HR ANDROGEL TRANSDERMAL GEL IN METERED-DOSE PUMP 20.25 MG/1.25 GRAM (1.62 %) ANDROGEL TRANSDERMAL GEL IN PACKET 1.62 % (20.25 MG/1.25 GRAM), 1.62 % (40.5 MG/2.5 GRAM) (Sodium Thiosulfate) androxy oral tablet 10 mg (Fluoxymesterone) danazol oral capsule 100 mg, 200 mg, 50 mg (Danazol) oxandrolone oral tablet 10 mg, 2.5 mg (Oxandrin) testosterone cypionate (Depointramuscular oil 100 mg/ml, 200 Testosterone) mg/ml testosterone enanthate (Testosterone intramuscular oil 200 mg/ml Enanthate) testosterone transdermal gel 50 mg/5 gram (1 %) (Testim) testosterone transdermal gel in metered-dose pump 1.25 gram/ (Vogelxo) actuation (1 %) testosterone transdermal gel in packet 1 % (25 mg/2.5gram) (Androgel) testosterone transdermal gel in packet 1 % (50 mg/5 gram) (Testim) PA; QL (30 per 30 days) PA; QL (150 per 30 days) PA; QL (150 per 30 days) PA PA; QL (5 per 28 days) PA; QL (300 per 30 days) PA; QL (300 per 30 days) PA; QL (300 per 30 days) PA; QL (300 per 30 days) www.centersplan.com/fida/participants 150

Estrogens And Antiestrogens COMBIPATCH TRANSDERMAL PATCH SEMIWEEKLY 0.05-0.14 MG/24 HR, 0.05-0.25 MG/24 HR DUAVEE ORAL TABLET 0.45-20 MG ESTRACE VAGINAL CREAM 0.01 % (0.1 MG/GRAM) estradiol oral tablet 0.5 mg, 1 mg, 2 mg estradiol transdermal patch semiweekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr estradiol transdermal patch weekly 0.025 mg/24 hr, 0.0375 mg/24 hr, 0.05 mg/24 hr, 0.06 mg/24 hr, 0.075 mg/24 hr, 0.1 mg/24 hr estradiol valerate intramuscular oil 10 mg/ml, 20 mg/ml, 40 mg/ml estradiol-norethindrone acet oral tablet 0.5-0.1 mg, 1-0.5 mg estropipate oral tablet 0.75 mg, 1.5 mg, 3 mg FEMRING VAGINAL RING 0.05 MG/24 HR, 0.1 MG/24 HR MENEST ORAL TABLET 0.3 MG, (Estrace) (Vivelle-Dot) (Climara) (Delestrogen) (Activella) (Estropipate) PA-HRM; QL (8 per 28 days) PA-HRM PA-HRM PA-HRM; QL (8 per 28 days) PA-HRM; QL (4 per 28 days) PA-HRM PA-HRM QL (1 per 84 days) PA-HRM 0.625 MG, 1.25 MG, 2.5 MG mimvey lo oral tablet 0.5-0.1 mg (Activella) PA-HRM mimvey oral tablet 1-0.5 mg (Activella) PA-HRM PREMARIN INJECTION RECON SOLN 25 MG PREMARIN ORAL TABLET 0.3 MG, 0.45 MG, 0.625 MG, 0.9 MG, 1.25 MG PREMARIN VAGINAL CREAM 0.625 MG/GRAM PA-HRM www.centersplan.com/fida/participants 151

PREMPHASE ORAL TABLET PA-HRM 0.625 MG (14)/ 0.625MG-5MG(14) PREMPRO ORAL TABLET 0.3- PA-HRM 1.5 MG, 0.45-1.5 MG, 0.625-2.5 MG, 0.625-5 MG raloxifene oral tablet 60 mg (Evista) VAGIFEM VAGINAL TABLET 10 QL (18 per 28 days) MCG Glucocorticoids/Mineraloco rticoids a-hydrocort injection recon soln 100 (Hydrocortisone mg Sod Succinate) betamethasone acet,sod phos injection suspension 6 mg/ml (Celestone) cortisone oral tablet 25 mg (Cortisone Acetate) dexamethasone oral elixir 0.5 mg/5 (Dexamethasone) ml dexamethasone oral tablet 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg (Dexamethasone) dexamethasone sodium phosphate (Dexamethasone injection solution 10 mg/ml, 4 mg/ml Sod Phosphate) fludrocortisone oral tablet 0.1 mg (Fludrocortisone Acetate) hydrocortisone oral tablet 10 mg, 20 (Cortef) mg, 5 mg methylprednisolone 125 mg vial 2ml sdv, 25's,l/f 125 mg (Solu-Medrol) methylprednisolone acetate injection suspension 40 mg/ml, 80 mg/ml (Depo-Medrol) methylprednisolone oral tablet 16 (Medrol) mg, 32 mg, 4 mg, 8 mg methylprednisolone oral (Medrol) tablets,dose pack 4 mg methylprednisolone sodium succ injection recon soln 125 mg, 40 mg (Solu-Medrol) www.centersplan.com/fida/participants 152

methylprednisolone ss 1 gm vl mdv,latex-free 1,000 mg (Solu-Medrol) prednisolone sodium phosphate oral solution 15 mg/5 ml (3 mg/ml), 25 mg/5 ml (5 mg/ml), 5 mg base/5 ml (6.7 mg/5 ml) (Pediapred) prednisone oral solution 5 mg/5 ml (Prednisone) prednisone oral tablet 1 mg, 2.5 mg, (Prednisone) 20 mg, 5 mg, 50 mg prednisone oral tablet 10 mg (Prednisone) prednisone oral tablets,dose pack 10 (Prednisone) mg, 5 mg SOLU-CORTEF (PF) INJECTION RECON SOLN 100 MG/2 ML triamcinolone acetonide injection (Triamcinolone suspension 10 mg/ml, 40 mg/ml Acetonide) Pituitary desmopressin injection solution 4 (Desmopressin mcg/ml Acetate) desmopressin nasal solution 0.1 QL (15 per 30 days) (DDAVP) mg/ml (refrigerate) desmopressin nasal spray,nonaerosol 10 mcg/spray (0.1 ml) Acetate) (Desmopressin QL (15 per 30 days) desmopressin oral tablet 0.1 mg, 0.2 mg (DDAVP) GENOTROPIN MINIQUICK PA SUBCUTANEOUS SYRINGE 0.2 MG/0.25 ML, 0.4 MG/0.25 ML, 0.6 MG/0.25 ML, 0.8 MG/0.25 ML, 1 MG/0.25 ML, 1.2 MG/0.25 ML, 1.4 MG/0.25 ML, 1.6 MG/0.25 ML, 1.8 MG/0.25 ML, 2 MG/0.25 ML GENOTROPIN SUBCUTANEOUS PA CARTRIDGE 12 MG/ML (36 UNIT/ML), 5 MG/ML (15 UNIT/ML) INCRELEX SUBCUTANEOUS SOLUTION 10 MG/ML www.centersplan.com/fida/participants 153

LUPRON DEPOT-PED (3 MONTH) INTRAMUSCULAR SYRINGE KIT 30 MG LUPRON DEPOT-PED INTRAMUSCULAR KIT 11.25 MG, 15 MG, 7.5 MG (PED) NORDITROPIN FLEXPRO SUBCUTANEOUS PEN INJECTOR 10 MG/1.5 ML (6.7 MG/ML), 15 MG/1.5 ML (10 MG/ML), 30 MG/3 ML (10 MG/ML), 5 MG/1.5 ML (3.3 MG/ML) octreotide acet 50 mcg/ml syr outer,single-dose,10 50 mcg/ml (1 ml) octreotide acetate injection solution 1,000 mcg/ml, 100 mcg/ml, 200 mcg/ml, 500 mcg/ml octreotide acetate injection solution 50 mcg/ml SAIZEN CLICK.EASY SUBCUTANEOUS CARTRIDGE 8.8 MG/1.5 ML (FNL) SAIZEN SUBCUTANEOUS RECON SOLN 5 MG, 8.8 MG SANDOSTATIN LAR 10 MG KIT 10 MG SANDOSTATIN LAR 20 MG KIT 20 MG SANDOSTATIN LAR 30 MG KIT 30 MG SANDOSTATIN LAR DEPOT INTRAMUSCULAR SUSPENSION,EXTENDED REL RECON 10 MG, 20 MG, 30 MG SEROSTIM SUBCUTANEOUS RECON SOLN 4 MG, 5 MG, 6 MG (Octreotide Acetate) (Sandostatin) (Octreotide Acetate) QL (1 per 84 days) PA PA PA PA www.centersplan.com/fida/participants 154

SOMATULINE DEPOT SUBCUTANEOUS SYRINGE 120 MG/0.5 ML, 60 MG/0.2 ML, 90 MG/0.3 ML SOMAVERT SUBCUTANEOUS RECON SOLN 10 MG, 15 MG, 20 MG, 25 MG, 30 MG SUPPRELIN LA IMPLANT KIT 50 MG (65 MCG/DAY) Progestins DEPO-PROVERA INTRAMUSCULAR SOLUTION 400 MG/ML medroxyprogesterone intramuscular suspension 150 mg/ml medroxyprogesterone intramuscular syringe 150 mg/ml medroxyprogesterone oral tablet 10 mg, 2.5 mg, 5 mg MEGACE ES ORAL SUSPENSION 625 MG/5 ML megestrol oral suspension 400 mg/10 ml (40 mg/ml), 625 mg/5 ml norethindrone acetate oral tablet 5 mg progesterone in oil intramuscular oil 50 mg/ml progesterone micronized oral capsule 100 mg, 200 mg Thyroid And Antithyroid Agents levothyroxine intravenous recon soln 100 mcg, 200 mcg, 500 mcg levothyroxine oral tablet 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 25 mcg, 300 mcg, 50 mcg, 75 mcg, 88 mcg liothyronine oral tablet 25 mcg, 5 mcg, 50 mcg (Depo-Provera) (Depo-Provera) (Provera) (Megace Es) (Aygestin) (Progesterone) (Prometrium) (Levothyroxine Sodium) (Levoxyl) (Cytomel) QL (1 per 28 days) QL (1 per 360 days) QL (10 per 28 days) QL (1 per 84 days) QL (1 per 84 days) www.centersplan.com/fida/participants 155

methimazole oral tablet 10 mg, 5 mg (Tapazole) propylthiouracil oral tablet 50 mg (Propylthiouracil) Immunological Agents Immunological Agents ARCALYST SUBCUTANEOUS RECON SOLN 220 MG ASTAGRAF XL ORAL CAPSULE,EXTENDED RELEASE 24HR 0.5 MG, 1 MG, 5 MG AUBAGIO ORAL TABLET 14 PA; QL (28 per 28 MG, 7 MG days) azathioprine oral tablet 50 mg (Imuran) azathioprine sodium injection recon (Azathioprine soln 100 mg Sodium) CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN 6 GRAM CELLCEPT INTRAVENOUS INTRAVENOUS RECON SOLN 500 MG CIMZIA POWDER FOR PA RECONST SUBCUTANEOUS KIT 400 MG (200 MG X 2 VIALS) CIMZIA SUBCUTANEOUS PA SYRINGE KIT 400 MG/2 ML (200 MG/ML X 2) cyclosporine intravenous solution (Sandimmune) 250 mg/5 ml cyclosporine modified oral capsule (Neoral) 100 mg, 25 mg, 50 mg cyclosporine modified oral solution (Neoral) 100 mg/ml cyclosporine oral capsule 100 mg, (Sandimmune) 25 mg ENBREL SUBCUTANEOUS PA RECON SOLN 25 MG (1 ML) www.centersplan.com/fida/participants 156

ENBREL SUBCUTANEOUS PA SYRINGE 25 MG/0.5ML (0.51), 50 MG/ML (0.98 ML) ENBREL SURECLICK PA SUBCUTANEOUS PEN INJECTOR 50 MG/ML (0.98 ML) ENVARSUS XR ORAL TABLET EXTENDED RELEASE 24 HR 0.75 MG, 1 MG, 4 MG FLEBOGAMMA DIF INTRAVENOUS SOLUTION 10 %, 5 % GAMASTAN S/D INTRAMUSCULAR SOLUTION 15-18 % RANGE GAMMAGARD LIQUID INJECTION SOLUTION 10 % GAMMAPLEX INTRAVENOUS SOLUTION 5 % gengraf oral capsule 100 mg, 25 mg (Neoral) gengraf oral solution 100 mg/ml (Neoral) HUMIRA PEN CROHN'S-UC-HS PA START SUBCUTANEOUS PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA PEN SUBCUTANEOUS PA PEN INJECTOR KIT 40 MG/0.8 ML HUMIRA SUBCUTANEOUS PA SYRINGE KIT 10 MG/0.2 ML, 20 MG/0.4 ML, 40 MG/0.8 ML HYPERRAB S/D (PF) INTRAMUSCULAR SOLUTION 150 UNIT/ML, 150 UNIT/ML (10 ML) www.centersplan.com/fida/participants 157

HYQVIA SUBCUTANEOUS SOLUTION 10 GRAM /100 ML (10 %), 2.5 GRAM /25 ML (10 %), 20 GRAM /200 ML (10 %), 30 GRAM /300 ML (10 %), 5 GRAM /50 ML (10 %) ILARIS (PF) SUBCUTANEOUS RECON SOLN 180 MG/1.2 ML (150 MG/ML) IMOGAM RABIES-HT (PF) INTRAMUSCULAR SOLUTION 150 UNIT/ML KINERET SUBCUTANEOUS SYRINGE 100 MG/0.67 ML leflunomide oral tablet 10 mg, 20 mg mycophenolate mofetil oral capsule 250 mg mycophenolate mofetil oral suspension for reconstitution 200 mg/ml mycophenolate mofetil oral tablet 500 mg mycophenolate sodium oral tablet,delayed release (dr/ec) 180 mg, 360 mg NULOJIX INTRAVENOUS RECON SOLN 250 MG OCTAGAM INTRAVENOUS SOLUTION 10 %, 5 % ORENCIA (WITH MALTOSE) INTRAVENOUS RECON SOLN 250 MG ORENCIA SUBCUTANEOUS SYRINGE 125 MG/ML PRIVIGEN INTRAVENOUS SOLUTION 10 % PROGRAF INTRAVENOUS SOLUTION 5 MG/ML (Arava) (Cellcept) (Cellcept) (Cellcept) (Myfortic) PA PA; QL (18.76 per 28 days) PA PA www.centersplan.com/fida/participants 158

RAPAMUNE ORAL SOLUTION 1 MG/ML RIDAURA ORAL CAPSULE 3 MG sirolimus oral tablet 0.5 mg, 1 mg, 2 mg tacrolimus oral capsule 0.5 mg, 1 mg, 5 mg TYSABRI INTRAVENOUS SOLUTION 300 MG/15 ML ZORTRESS ORAL TABLET 0.25 MG, 0.5 MG, 0.75 MG Vaccines ACTHIB (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SUSPENSION 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML ADACEL(TDAP ADOLESN/ADULT)(PF) INTRAMUSCULAR SYRINGE 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML BCG (TICE STRAIN) VIAL 50 MG BCG VACCINE, LIVE (PF) PERCUTANEOUS SUSPENSION FOR RECONSTITUTION 50 MG BEXSERO (PF) INTRAMUSCULAR SYRINGE 50-50-50-25 MCG/0.5 ML BOOSTRIX TDAP INTRAMUSCULAR SUSPENSION 2.5-8-5 LF-MCG- LF/0.5ML BOOSTRIX TDAP INTRAMUSCULAR SYRINGE 2.5-8-5 LF-MCG-LF/0.5ML (Rapamune) (Hecoria) PA; LA; QL (15 per 28 days) ; QL (120 per 30 days) www.centersplan.com/fida/participants 159

CERVARIX VACCINE (PF) INTRAMUSCULAR SYRINGE 20-20 MCG/0.5 ML COMVAX (PF) INTRAMUSCULAR SUSPENSION 5-7.5-125 MCG/0.5 ML DAPTACEL (DTAP PEDIATRIC) (PF) INTRAMUSCULAR SUSPENSION 15-10-5 LF-MCG- LF/0.5ML ENGERIX-B (PF) INTRAMUSCULAR SYRINGE 20 MCG/ML ENGERIX-B 20 MCG/ML VIAL 10'S,ADULT,P/F,OUTER 20 MCG/ML ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SUSPENSION 10 MCG/0.5 ML ENGERIX-B PEDIATRIC (PF) INTRAMUSCULAR SYRINGE 10 MCG/0.5 ML GARDASIL (PF) INTRAMUSCULAR SUSPENSION 20-40-40-20 MCG/0.5 ML GARDASIL (PF) INTRAMUSCULAR SYRINGE 20-40-40-20 MCG/0.5 ML GARDASIL 9 (PF) INTRAMUSCULAR SUSPENSION 0.5 ML GARDASIL 9 (PF) INTRAMUSCULAR SYRINGE 0.5 ML ; QL (3 per 365 days) ; QL (3 per 365 days) ; QL (3 per 365 days) ; QL (3 per 365 days) QL (1.5 per 365 days) QL (1.5 per 365 days) QL (1.5 per 365 days) QL (1.5 per 365 days) www.centersplan.com/fida/participants 160

HAVRIX (PF) INTRAMUSCULAR SUSPENSION 1,440 ELISA UNIT/ML HAVRIX (PF) INTRAMUSCULAR SYRINGE 1,440 ELISA UNIT/ML, 720 ELISA UNIT/0.5 ML IMOVAX RABIES VACCINE (PF) INTRAMUSCULAR RECON SOLN 2.5 UNIT INFANRIX (DTAP) (PF) INTRAMUSCULAR SUSPENSION 25-58-10 LF-MCG- LF/0.5ML IPOL INJECTION SUSPENSION 40-8-32 UNIT/0.5 ML IPOL INJECTION SYRINGE 40-8- 32 UNIT/0.5 ML IXIARO (PF) INTRAMUSCULAR SYRINGE 6 MCG/0.5 ML KINRIX (PF) INTRAMUSCULAR SUSPENSION 25 LF-58 MCG-10 LF/0.5 ML KINRIX (PF) INTRAMUSCULAR SYRINGE 25 LF-58 MCG-10 LF/0.5 ML MENACTRA (PF) INTRAMUSCULAR SOLUTION 4 MCG/0.5 ML MENHIBRIX (PF) INTRAMUSCULAR RECON SOLN 5-2.5 MCG/0.5 ML MENOMUNE - A/C/Y/W-135 (PF) SUBCUTANEOUS RECON SOLN 50 MCG MENVEO A-C-Y-W-135-DIP (PF) INTRAMUSCULAR KIT 10-5 MCG/0.5 ML www.centersplan.com/fida/participants 161

MENVEO MENA COMPONENT (PF) INTRAMUSCULAR RECON SOLN 10 MCG /0.5 ML (FINAL) MENVEO MENCYW-135 COMPNT (PF) INTRAMUSCULAR RECON SOLN 5 MCG X 3/ 0.5 ML (FINAL) M-M-R II (PF) SUBCUTANEOUS RECON SOLN 1,000-12,500 TCID50/0.5 ML PEDIARIX (PF) INTRAMUSCULAR SYRINGE 10 MCG-25LF-25 MCG-10LF/0.5 ML PEDVAX HIB (PF) INTRAMUSCULAR SOLUTION 7.5 MCG/0.5 ML PENTACEL (PF) INTRAMUSCULAR KIT 15 LF UNIT-20 MCG-5 LF/0.5 ML PENTACEL ACTHIB COMPONENT (PF) INTRAMUSCULAR RECON SOLN 10 MCG/0.5 ML PROQUAD (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10EXP3-4.3-3- 3.99 TCID50/0.5 QUADRACEL (PF) INTRAMUSCULAR SUSPENSION 15 LF-48 MCG- 5 LF UNIT/0.5ML RABAVERT (PF) INTRAMUSCULAR SUSPENSION FOR RECONSTITUTION 2.5 UNIT QL (2 per 365 days) QL (2 per 365 days) www.centersplan.com/fida/participants 162

RECOMBIVAX HB (PF) INTRAMUSCULAR SUSPENSION 10 MCG/ML, 40 MCG/ML RECOMBIVAX HB (PF) INTRAMUSCULAR SYRINGE 10 MCG/ML, 5 MCG/0.5 ML ROTARIX ORAL SUSPENSION FOR RECONSTITUTION 10EXP6 CCID50/ML ROTATEQ VACCINE ORAL SUSPENSION 2 ML TENIVAC (PF) INTRAMUSCULAR SYRINGE 5-2 LF UNIT/0.5 ML TETANUS TOXOID,ADSORBED (PF) INTRAMUSCULAR SUSPENSION 5 LF UNIT/0.5 ML TETANUS,DIPHTHERIA TOX PED(PF) INTRAMUSCULAR SUSPENSION 5-25 LF UNIT/0.5 ML tetanus-diphtheria toxoids-td intramuscular suspension 2-2 lf unit/0.5 ml TRUMENBA INTRAMUSCULAR SYRINGE 120 MCG/0.5 ML TWINRIX (PF) INTRAMUSCULAR SUSPENSION 720 ELISA UNIT - 20 MCG/ML TWINRIX (PF) INTRAMUSCULAR SYRINGE 720 ELISA UNIT -20 MCG/ML TYPHIM VI INTRAMUSCULAR SOLUTION 25 MCG/0.5 ML TYPHIM VI INTRAMUSCULAR SYRINGE 25 MCG/0.5 ML (Tetanus, Diphtheria Tox,Adult) ; QL (3 per 365 days) ; QL (3 per 365 days) www.centersplan.com/fida/participants 163

VAQTA (PF) INTRAMUSCULAR SUSPENSION 50 UNIT/ML VAQTA (PF) INTRAMUSCULAR SYRINGE 25 UNIT/0.5 ML, 50 UNIT/ML VAQTA 25 UNITS/0.5 ML VIAL SDV, OUTER 25 UNIT/0.5 ML VARIVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 1,350 UNIT/0.5 ML YF-VAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 10 EXP4.74 UNIT/0.5 ML ZOSTAVAX (PF) SUBCUTANEOUS SUSPENSION FOR RECONSTITUTION 19,400 UNIT/0.65 ML Inflammatory Bowel Disease Agents Inflammatory Bowel Disease Agents alosetron oral tablet 0.5 mg, 1 mg (Alosetron HCl) APRISO ORAL CAPSULE,EXTENDED RELEASE 24HR 0.375 GRAM ASACOL HD ORAL TABLET,DELAYED RELEASE (DR/EC) 800 MG balsalazide oral capsule 750 mg (Colazal) budesonide oral capsule,delayed,extend.release 3 mg (Entocort EC) DELZICOL ORAL CAPSULE,DELAYED RELEASE(DR/EC) 400 MG DIPENTUM ORAL CAPSULE 250 MG QL (2 per 365 days) QL (1 per 365 days) ST www.centersplan.com/fida/participants 164

Irrigating Solutions Irrigating Solutions acetic acid irrigation solution 0.25 % (Acetic Acid) LACTATED RINGERS IRRIGATION SOLUTION ringers irrigation solution (Tis-U-Sol) sodium chloride irrigation solution (Sodium Chloride 0.9 % Irrig Solution) sorbitol irrigation solution 3 %, 3.3 % (Sorbitol Solution) sorbitol-mannitol urethral solution (Mannitol/Sorbitol 2.7-0.54 g/100 ml Solution) water for irrigation, sterile (Water For irrigation solution Irrigation,Sterile) Metabolic Bone Disease Agents Metabolic Bone Disease Agents alendronate oral solution 70 mg/75 ml alendronate oral tablet 10 mg, 40 mg, 5 mg alendronate oral tablet 35 mg, 70 mg calcitonin (salmon) nasal spray,non-aerosol 200 unit/actuation (Alendronate Sodium) (Fosamax) (Fosamax) (Miacalcin) calcitriol intravenous solution 1 mcg/ml (Calcitriol) calcitriol oral capsule 0.25 mcg, 0.5 mcg (Rocaltrol) calcitriol oral solution 1 mcg/ml (Rocaltrol) doxercalciferol intravenous solution 4 mcg/2 ml (Doxercalciferol) doxercalciferol oral capsule 0.5 mcg, 1 mcg, 2.5 mcg (Hectorol) QL (300 per 28 days) QL (4 per 28 days) QL (3.7 per 28 days) www.centersplan.com/fida/participants 165

FORTEO SUBCUTANEOUS PEN INJECTOR 20 MCG/DOSE - 600 MCG/2.4 ML FORTICAL NASAL SPRAY,NON- AEROSOL 200 UNIT/ACTUATION ibandronate intravenous solution 3 mg/3 ml ibandronate intravenous syringe 3 mg/3 ml (Ibandronate Sodium) (Boniva) PA; QL (2.4 per 28 days) QL (3.7 per 28 days) QL (3 per 84 days) QL (3 per 84 days) ibandronate oral tablet 150 mg (Boniva) QL (1 per 28 days) MIACALCIN INJECTION SOLUTION 200 UNIT/ML NATPARA SUBCUTANEOUS PA; QL (2 per 28 days) CARTRIDGE 100 MCG/DOSE, 25 MCG/DOSE, 50 MCG/DOSE, 75 MCG/DOSE paricalcitol oral capsule 1 mcg, 2 mcg, 4 mcg (Zemplar) PROLIA SUBCUTANEOUS QL (1 per 180 days) SYRINGE 60 MG/ML risedronate oral tablet 150 mg (Actonel) QL (1 per 28 days) risedronate oral tablet 30 mg, 5 mg (Actonel) QL (30 per 28 days) ZEMPLAR INTRAVENOUS SOLUTION 2 MCG/ML, 5 MCG/ML zoledronic acid intravenous solution 4 mg/5 ml zoledronic acid-mannitol-water intravenous piggyback 4 mg/100 ml zoledronic acid-mannitol-water intravenous solution 5 mg/100 ml ZOMETA INTRAVENOUS SOLUTION 4 MG/100 ML Miscellaneous Therapeutic Agents (Zometa) (Zoledronic Acid/Mannitol and Water) (Reclast) QL (100 per 300 days) www.centersplan.com/fida/participants 166

Miscellaneous Therapeutic Agents ACTEMRA INTRAVENOUS SOLUTION 200 MG/10 ML (20 MG/ML), 400 MG/20 ML (20 MG/ML), 80 MG/4 ML (20 MG/ML) ACTEMRA SUBCUTANEOUS SYRINGE 162 MG/0.9 ML ACTIMMUNE SUBCUTANEOUS SOLUTION 100 MCG/0.5 ML allopurinol oral tablet 100 mg, 300 mg amifostine crystalline intravenous recon soln 500 mg anticoag citrate phos dextrose solution 2.63-222 gram-mg/100ml AVONEX (WITH ALBUMIN) INTRAMUSCULAR KIT 30 MCG AVONEX INTRAMUSCULAR PEN INJECTOR KIT 30 MCG/0.5 ML AVONEX INTRAMUSCULAR SYRINGE KIT 30 MCG/0.5 ML BENLYSTA INTRAVENOUS RECON SOLN 120 MG, 400 MG BETASERON SUBCUTANEOUS KIT 0.3 MG bethanechol chloride oral tablet 10 mg, 25 mg, 5 mg, 50 mg buspirone oral tablet 10 mg, 15 mg, 30 mg, 5 mg, 7.5 mg CERDELGA ORAL CAPSULE 84 MG (Zyloprim) (Amifostine Crystalline) (Citrate Phosphate Dextros Soln) (Urecholine) (Buspirone HCl) colchicine oral tablet 0.6 mg (Colcrys) colchicine-probenecid oral tablet (Colchicine/Proben 0.5-500 mg ecid) PA PA ST ST ST PA ST PA www.centersplan.com/fida/participants 167

COPAXONE SUBCUTANEOUS SYRINGE 20 MG/ML, 40 MG/ML CYSTADANE ORAL POWDER 1 GRAM/1.7 ML droperidol injection solution 2.5 mg/ml (Droperidol) dutasteride oral capsule 0.5 mg (Avodart) dutasteride-tamsulosin oral capsule, er multiphase 24 hr 0.5-0.4 mg (Jalyn) ELMIRON ORAL CAPSULE 100 MG ergoloid oral tablet 1 mg (Ergoloid Mesylates) EXTAVIA SUBCUTANEOUS KIT 0.3 MG finasteride oral tablet 5 mg (Proscar) fomepizole intravenous solution 1 gram/ml (Fomepizole) FUSILEV INTRAVENOUS RECON SOLN 50 MG GAUZE PAD TOPICAL BANDAGE 2 X 2 " GILENYA ORAL CAPSULE 0.5 MG GLUCAGEN HYPOKIT INJECTION RECON SOLN 1 MG GLUCAGON EMERGENCY KIT (HUMAN) INJECTION KIT 1 MG guanidine oral tablet 125 mg (Guanidine HCl) hydroxyzine hcl intramuscular solution 25 mg/ml, 50 mg/ml (Hydroxyzine HCl) hydroxyzine hcl oral solution 10 mg/5 ml (Hydroxyzine HCl) hydroxyzine hcl oral tablet 10 mg, 25 mg, 50 mg (Hydroxyzine HCl) hydroxyzine pamoate oral capsule 100 mg, 25 mg, 50 mg (Vistaril) QL (30 per 30 days) ST QL (28 per 28 days) PA-HRM PA-HRM PA-HRM PA-HRM www.centersplan.com/fida/participants 168

KEVEYIS ORAL TABLET 50 MG LEMTRADA INTRAVENOUS SOLUTION 12 MG/1.2 ML leucovorin calcium 200 mg vial sdv, (Leucovorin p/f, latex-free 200 mg Calcium) leucovorin calcium injection recon (Leucovorin soln 100 mg, 350 mg Calcium) leucovorin calcium oral tablet 10 (Leucovorin mg, 15 mg, 25 mg, 5 mg Calcium) levocarnitine (with sugar) oral (Levocarnitine solution 100 mg/ml (With Sugar)) levocarnitine oral tablet 330 mg (Carnitor) mesna intravenous solution 100 mg/ml (Mesnex) MESNEX ORAL TABLET 400 MG MESTINON ORAL SYRUP 60 MG/5 ML MESTINON TIMESPAN ORAL TABLET EXTENDED RELEASE 180 MG MINERAL OIL HEAVY * morrhuate sodium intravenous (Sodium solution 5 % Morrhuate) OTEZLA ORAL TABLET 30 MG OTEZLA STARTER ORAL TABLETS,DOSE PACK 10 MG (4)-20 MG (4)-30 MG (47), 10 MG (4)-20 MG (4)-30 MG(19) OTREXUP (PF) SUBCUTANEOUS AUTO- INJECTOR 10 MG/0.4 ML, 15 MG/0.4 ML, 17.5 MG/0.4 ML, 20 MG/0.4 ML, 22.5 MG/0.4 ML, 25 MG/0.4 ML, 7.5 MG/0.4 ML PANTILINERS PAD * PA NSO; QL (120 per 30 days) PA PA; QL (60 per 30 days) PA; QL (60 per 30 days) www.centersplan.com/fida/participants 169

PLEGRIDY SUBCUTANEOUS PEN INJECTOR 125 MCG/0.5 ML, 63 MCG/0.5 ML- 94 MCG/0.5 ML PLEGRIDY SUBCUTANEOUS SYRINGE 125 MCG/0.5 ML, 63 MCG/0.5 ML- 94 MCG/0.5 ML probenecid oral tablet 500 mg (Probenecid) PROCYSBI ORAL CAPSULE, DELAYED REL SPRINKLE 25 MG, 75 MG pv extra cleansing douche * (Acetic Acid) pyridostigmine bromide oral tablet 60 mg (Mestinon) pyridostigmine bromide oral tablet extended release 180 mg (Mestinon) qc mineral oil heavy * (Mineral Oil) ra feminine care douche * (Acetic Acid) RASUVO (PF) SUBCUTANEOUS AUTO-INJECTOR 10 MG/0.2 ML, 12.5 MG/0.25 ML, 15 MG/0.3 ML, 17.5 MG/0.35 ML, 20 MG/0.4 ML, 22.5 MG/0.45 ML, 25 MG/0.5 ML, 27.5 MG/0.55 ML, 30 MG/0.6 ML, 7.5 MG/0.15 ML REBIF (WITH ALBUMIN) SUBCUTANEOUS SYRINGE 22 MCG/0.5 ML, 44 MCG/0.5 ML REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML, 8.8MCG/0.2ML-22 MCG/0.5ML (6) REBIF TITRATION PACK SUBCUTANEOUS SYRINGE 8.8MCG/0.2ML-22 MCG/0.5ML (6) REMICADE INTRAVENOUS RECON SOLN 100 MG sb disp douche extra clns v&w * (Acetic Acid) ST ST PA www.centersplan.com/fida/participants 170

SENSIPAR ORAL TABLET 30 MG, 60 MG, 90 MG SIGNIFOR SUBCUTANEOUS QL (60 per 30 days) SOLUTION 0.3 MG/ML (1 ML), 0.6 MG/ML (1 ML), 0.9 MG/ML (1 ML) SIMPONI ARIA INTRAVENOUS PA SOLUTION 12.5 MG/ML SIMPONI SUBCUTANEOUS PEN PA INJECTOR 100 MG/ML, 50 MG/0.5 ML SIMPONI SUBCUTANEOUS PA SYRINGE 100 MG/ML, 50 MG/0.5 ML STELARA SUBCUTANEOUS PA SYRINGE 45 MG/0.5 ML, 90 MG/ML STERILE PADS 2" X 2" 2 X 2 " summer's eve dche-xtra clns 12's,extra-cleansing * (Acetic Acid) summer's eve douche-ultra clns 12's,2pk,ultra clns * (Acetic Acid) SYNAREL NASAL SPRAY,NON- AEROSOL 2 MG/ML TECFIDERA ORAL QL (14 per 30 days) CAPSULE,DELAYED RELEASE(DR/EC) 120 MG TECFIDERA ORAL QL (60 per 30 days) CAPSULE,DELAYED RELEASE(DR/EC) 120 MG (14)- 240 MG (46), 240 MG THALOMID ORAL CAPSULE 100 PA NSO; QL (60 per MG, 150 MG, 200 MG, 50 MG 30 days) topical light mineral oil * (Mineral Oil) TYBOST ORAL TABLET 150 MG QL (30 per 30 days) ULORIC ORAL TABLET 40 MG, QL (30 per 30 days) 80 MG www.centersplan.com/fida/participants 171

XELJANZ ORAL TABLET 5 MG XELJANZ XR ORAL TABLET EXTENDED RELEASE 24 HR 11 MG Ophthalmic Agents Antiglaucoma Agents acetazolamide oral capsule, extended release 500 mg (Diamox Sequels) acetazolamide oral tablet 125 mg, 250 mg (Acetazolamide) acetazolamide sodium injection (Acetazolamide recon soln 500 mg Sodium) ALPHAGAN P OPHTHALMIC DROPS 0.1 % AZOPT OPHTHALMIC DROPS,SUSPENSION 1 % betaxolol ophthalmic drops 0.5 % (Betaxolol HCl) bimatoprost ophthalmic drops 0.03 % (Bimatoprost) brimonidine ophthalmic drops 0.15 %, 0.2 % (Alphagan P) COMBIGAN OPHTHALMIC DROPS 0.2-0.5 % dorzolamide ophthalmic drops 2 % (Trusopt) dorzolamide-timolol ophthalmic drops 22.3-6.8 mg/ml (Cosopt) latanoprost ophthalmic drops 0.005 % (Xalatan) levobunolol ophthalmic drops 0.25 %, 0.5 % (Betagan) LUMIGAN OPHTHALMIC DROPS 0.01 % methazolamide oral tablet 25 mg, 50 (Neptazane) mg metipranolol ophthalmic drops 0.3 % (Metipranolol) PA; QL (60 per 30 days) PA; QL (30 per 30 days) (drops: 0.15%, 0.20%) QL (2.5 per 25 days) www.centersplan.com/fida/participants 172

PHOSPHOLINE IODIDE OPHTHALMIC DROPS 0.125 % pilocarpine hcl ophthalmic drops 1 %, 2 %, 4 % SIMBRINZA OPHTHALMIC DROPS,SUSPENSION 1-0.2 % timolol maleate ophthalmic drops 0.25 %, 0.5 % timolol maleate ophthalmic gel forming solution 0.25 %, 0.5 % TRAVATAN Z OPHTHALMIC DROPS 0.004 % travoprost (benzalkonium) ophthalmic drops 0.004 % Replacement Preparations Replacement Preparations calcitrate + vit d caplet 315-250 mg-unit * calcitrate 200 mg (950 mg) tab 200 mg (950 mg) * calcium 1,000 + d3 caplet 1,000 mg(2,500 mg)-800 unit * calcium 500 + d tablet p/f,na/f,no lactose 500 mg(1,250mg) -400 unit * calcium 500+d tablet chew 500 mg(1,250mg) -400 unit * calcium 600 + vit d 400 softgl 600 mg(1,500mg) -400 unit * calcium 600 + vit d tablet 600-125 mg-unit * calcium 600 + vitamin d sftgl rapid release, sftgl 600 mg(1,500mg) -500 unit * calcium 600 mg tablet 600 mg (1,500 mg) * (Isopto Carpine) (Timoptic) (Timoptic-Xe) (Travoprost (Benzalkonium)) (Citracal-Vitamin D) (Calcium Citrate) (Caltrate 600 + D) (Caltrate 600 + D) (Calcium 600 + Vit D) (Calcium Carbonate/Vitamin D3) (Caltrate 600 + D) (Calcium Carbonate/Vitamin D3) (Calcium Carbonate) QL (2.5 per 25 days) QL (2.5 per 25 days) www.centersplan.com/fida/participants 173

calcium 600+d softgel 600 mg calcium- 200 unit * calcium 600-vit d3 200 tablet 600 mg(1,500mg) -200 unit * calcium 600-vit d3 400 tablet 600 mg(1,500mg) -400 unit * calcium carb 1,250 mg/5 ml sus 500 mg/5 ml (1,250 mg/5 ml) * calcium carbonate 648 mg tab 260 mg calcium (648 mg) * calcium chloride intravenous solution 100 mg/ml (10 %) calcium chloride intravenous syringe 100 mg/ml (10 %) calcium citrate - vit d caplet caplet, coated 315-200 mg-unit * calcium citrate-vit d3 caplet s/f, p/f 315-250 mg-unit * calcium gluconate 500 mg tab 45 mg (500 mg) * calcium gluconate intravenous solution 100 mg/ml (10%) calcium with vit d tablet 600-125 mg-unit * CALTRATE 600 + D SOFT CHEW TAB VANILLA CREME 600 MG (1,500 MG)-800 UNIT * CALTRATE 600 PLUS D3 TABLET 600 MG(1,500MG) -800 UNIT * citracal + d maximum caplet 315-250 mg-unit * citrus calcium + d tablet 315-250 mg-unit * (Calcium Carbonate/Vitamin D3) (Caltrate 600 + D) (Caltrate 600 + D) (Calcium Carbonate) (Calcium Carbonate) (Calcium Chloride) (Calcium Chloride) (Citracal-Vitamin D) (Citracal-Vitamin D) (Calcium Gluconate) (Calcium Gluconate) (Calcium Carbonate/Vitamin D2) (Citracal-Vitamin D) (Citracal-Vitamin D) www.centersplan.com/fida/participants 174

cvs calcium + vitamin d3 sftgl absorbable 600 mg(1,500mg) -500 unit * cvs calcium 500 + vit d tablet oyster shell 500 mg(1,250mg) -125 unit * cvs calcium 600-vit d3 800 tab p/f, s/f,gluten-free 600 mg(1,500mg) - 800 unit * cvs magnesium 250 mg tablet 250 mg * (Calcium Carbonate/Vitamin D3) (Caltrate 600 + D) (Caltrate 600 + D) (Magnesium) cvs pediatric electrolyte soln * (Pedialyte) cvs pediatric electrolyte soln a/f, p/f * (Pedialyte) d10 %-0.45 % sodium chloride (Dextrose 10 % intravenous parenteral solution and 0.45 % NaCl) d2.5 %-0.45 % sodium chloride (Dextrose 2.5 % intravenous parenteral solution and 0.45 % NaCl) d5 % and 0.9 % sodium chloride (Dextrose 5 % and intravenous parenteral solution 0.9 % NaCl) d5 %-0.45 % sodium chloride (Dextrose 5 %-0.45 intravenous parenteral solution % NaCl) dextrose 10 % and 0.2 % nacl (Dextrose 10 % intravenous parenteral solution and 0.2 % NaCl) dextrose 5 %-lactated ringers (Dextrose 5%- intravenous parenteral solution Lactated Ringers) dextrose 5%-0.2 % sod chloride (Dextrose 5 %-0.2 intravenous parenteral solution % NaCl) dextrose 5%-0.3 % sod.chloride (Dextrose 5 % and intravenous parenteral solution 0.3 % NaCl) dextrose with sodium chloride (Dextrose 5 %-0.2 intravenous parenteral solution 5- % NaCl) 0.2 % effer-k oral tablet, effervescent 25 meq (Klor-Con-Ef) electrolyte-48 in d5w intravenous parenteral solution (Electrolyte-48 Solution/D5W) www.centersplan.com/fida/participants 175

eql calcium 600 mg + d softgel 600 mg(1,500mg) -100 unit * gnp calcium 500 + vit d3 tab 500mg (1,250mg) -600 unit * gnp calcium 600+d3+min chew tb p/f,gluten/f,yeast/f 600 mg calcium- 800 unit-40 mg * hm calcium 600+d plus tab chew gluten-free 600 mg calcium- 800 unit-40 mg * hm calcium citrate-vit d cplt caplet, gluten-free 315-250 mg-unit * HYPERLYTE CR INTRAVENOUS SOLUTION 25-20-5-5-30-30 MEQ/20 ML IONOSOL-B IN D5W INTRAVENOUS PARENTERAL SOLUTION 5 % IONOSOL-MB IN D5W INTRAVENOUS PARENTERAL SOLUTION 5 % ISOLYTE M IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION ISOLYTE-H IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 % ISOLYTE-P IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 % ISOLYTE-S INTRAVENOUS PARENTERAL SOLUTION k-effervescent oral tablet, effervescent 25 meq KELP 150 MCG TABLET 150 MCG * klor-con 10 oral tablet extended release 10 meq (Calcium Carbonate/Vitamin D3) (Caltrate 600 + D) (Ca/D3/Mag Ox/Zinc/Cop/Mang /Bor) (Ca/D3/Mag Ox/Zinc/Cop/Mang /Bor) (Citracal-Vitamin D) (Klor-Con-Ef) (Potassium Chloride) www.centersplan.com/fida/participants 176

klor-con m10 tablet 10 meq (Potassium Chloride) klor-con m15 oral tablet,er (Potassium particles/crystals 15 meq Chloride) klor-con m20 oral tablet,er (Potassium particles/crystals 20 meq Chloride) klor-con sprinkle oral capsule, (Potassium extended release 10 meq, 8 meq Chloride) (Calcium liquid calcium 600-vit d3 sfgl 600 Carbonate/Vitamin mg(1,500mg) -400 unit * D3) liquid calcium 600-vit d3 sfgl (Calcium softgel,p/f,gluten-f 600 mg(1,500mg) Carbonate/Vitamin -500 unit * D3) liquid calcium with vitamin d softgel, s/f, p/f 600 mg calcium- 200 (Calcium Carbonate/Vitamin unit * D3) mag delay dr 64 mg tablet 64 mg * (Slow-Mag) mag64 dr 64 mg tablet 64 mg * (Slow-Mag) mag-g 500 mg tablet 27 mg (500 mg) * (Magonate) magnesium 250 mg tablet 250 mg * (Magnesium) (Magnesium magnesium 300 mg capsule 300 mg Oxide/Mag Aa * Chelate) magnesium chloride injection (Magnesium solution 200 mg/ml (20 %) Chloride) magnesium gluc 500 mg tablet 27 mg (500 mg) * (Magonate) magnesium sulf in 0.45% nacl intravenous solution 20 gram/500 ml (40 mg/ml) magnesium sulfate in d5w intravenous piggyback 1 gram/100 ml, 4 gram/100 ml (Magnesium Sulf In 0.45% NaCl) (Magnesium Sulfate/D5W) www.centersplan.com/fida/participants 177

magnesium sulfate in water intravenous parenteral solution 20 gram/500 ml (4 %), 40 gram/1,000 ml (4 %) magnesium sulfate in water intravenous piggyback 2 gram/50 ml (4 %), 4 gram/100 ml (4 %), 4 gram/50 ml (8 %) magnesium sulfate injection solution 4 meq/ml (50 %) magnesium sulfate injection syringe 4 meq/ml natural calcium 500 mg tablet 500 mg calcium (1,250 mg) * NORMOSOL-M IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION (Magnesium Sulfate in Water) (Magnesium Sulfate in Water) (Magnesium Sulfate) (Magnesium Sulfate) (Calcium Carbonate) NORMOSOL-R PH 7.4 INTRAVENOUS PARENTERAL SOLUTION nu-mag 71.5 mg tablet 71.5 mg * (Slow-Mag) NUTRILYTE II INTRAVENOUS SOLUTION 35-20-5 MEQ/20 ML NUTRILYTE INTRAVENOUS SOLUTION 25-40.6-5 MEQ/20 ML oysco 500+d tablet 500 mg(1,250mg) -200 unit * (Caltrate 600 + D) oysco d tablet 250-125 mg-unit * (Caltrate 600 + D) oysco-500 tablet 500 mg calcium (Calcium (1,250 mg) * Carbonate) oyster shell 250 mg + vit d tb 250-125 mg-unit * (Caltrate 600 + D) oyster shell calcium 500 mg tb 500mg elemental ca 500 mg calcium (1,250 mg) * oyster shell calcium tablet 500 mg(1,250mg) -400 unit * (Calcium Carbonate) (Caltrate 600 + D) www.centersplan.com/fida/participants 178

oyster shell calcium-vit d tab 500 mg(1,250mg) -200 unit * (Caltrate 600 + D) oyster shell calcium-vit d tab p/f,s/f,gluten-free 500 mg(1,250mg) (Caltrate 600 + D) -400 unit * oystercal-d 500 mg-400 unit tb 500 mg(1,250mg) -400 unit * (Caltrate 600 + D) pediatric electrolyte solution * (Pedialyte) PHOS-NAK PACKET 280-160-250 MG * phospha 250 neutral oral tablet 250 mg (K-Phos Neutral) PLASMA-LYTE 148 INTRAVENOUS PARENTERAL SOLUTION PLASMA-LYTE A INTRAVENOUS PARENTERAL SOLUTION PLASMA-LYTE-56 IN 5 % DEXTROSE INTRAVENOUS PARENTERAL SOLUTION 5 % potassium acetate intravenous (Potassium solution 2 meq/ml, 4 meq/ml Acetate) potassium bicarb and chloride oral (Pot Chloride/Pot tablet, effervescent 25 meq Bicarb/Cit Ac) potassium bicarb-citric acid oral tablet, effervescent 25 meq (Klor-Con-Ef) potassium chlorid-d5-0.45%nacl intravenous parenteral solution 10 meq/l, 20 meq/l, 30 meq/l, 40 meq/l (Potassium Chloride/D5-0.45nacl) potassium chloride in 0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 30 meq/l, 40 meq/l (Potassium Chloride In 0.9%NaCl) (Potassium Chloride In D5w) www.centersplan.com/fida/participants 179

potassium chloride in lr-d5 intravenous parenteral solution 20 meq/l potassium chloride intravenous piggyback 10 meq/100 ml, 20 meq/100 ml, 30 meq/100 ml, 40 meq/100 ml potassium chloride intravenous solution 2 meq/ml potassium chloride oral capsule, extended release 10 meq, 8 meq potassium chloride oral liquid 20 meq/15 ml, 40 meq/15 ml potassium chloride oral packet 20 meq potassium chloride oral tablet extended release 8 meq potassium chloride oral tablet,er particles/crystals 10 meq potassium chloride oral tablet,er particles/crystals 20 meq potassium chloride-0.45 % nacl intravenous parenteral solution 20 meq/l potassium chloride-d5-0.2%nacl intravenous parenteral solution 10 meq/l, 20 meq/l, 30 meq/l, 40 meq/l potassium chloride-d5-0.3%nacl intravenous parenteral solution 20 meq/l potassium chloride-d5-0.9%nacl intravenous parenteral solution 20 meq/l, 40 meq/l potassium citrate oral tablet extended release 10 meq (1,080 mg), 15 meq, 5 meq (540 mg) potassium citrate-citric acid oral packet 3,300-1,002 mg (Potassium Chloride In Lr-D5) (Potassium Chloride) (Potassium Chloride) (Potassium Chloride) (Potassium Chloride) (Klor-Con) (K-Tab ER) (K-Tab ER) (Potassium Chloride) (Potassium Chloride-0.45% NaCl) (Potassium Chloride/D5-0.2%NaCl) (Potassium Chloride/D5-0.3%NaCl) (Potassium Chloride/D5-0.9%NaCl) (Urocit-K) (Potassium Citrate/Citric Acid) www.centersplan.com/fida/participants 180

potassium cl 10 meq/50 ml sol 10 meq/50 ml potassium cl 20 meq/50 ml sol 20 meq/50 ml potassium cl er 10 meq tablet f/c 10 meq potassium phosphate m-/d-basic intravenous solution 3 mmol/ml ra hi-cal plus vitamin d tab 500 mg(1,250mg) -200 unit * ra oyster shell-vitamin d tab s/f, p/f 250 (625)-125 mg-unit * (Potassium Chloride) (Potassium Chloride) (K-Tab ER) (Potassium Phos,M-Basic-D- Basic) (Caltrate 600 + D) (Calcium Carbonate/Vitamin D2) ra pediatric electrolyte soln a/f * (Pedialyte) ra pediatric freezer pops * (Pedialyte) ringers intravenous parenteral solution (Ringers Solution) sm calcium 600-vit d3 800 tab 600 mg(1,500mg) -800 unit * sm pediatric electrolyte soln * (Pedialyte) sodium acetate intravenous solution 2 meq/ml, 4 meq/ml (Sodium Acetate) sodium bicarbonate intravenous solution 1 meq/ml (8.4 %) sodium bicarbonate intravenous syringe 10 meq/10 ml (8.4 %), 4.2 % (0.5 meq/ml), 7.5 % (0.9 meq/ml), 8.4 % (1 meq/ml) sodium chloride 0.45 % intravenous parenteral solution 0.45 % sodium chloride 0.9 % intravenous parenteral solution 0.9 % sodium chloride 3 % intravenous parenteral solution 3 % sodium chloride 5 % intravenous parenteral solution 5 % (Sodium Bicarbonate) (Sodium Bicarbonate) (Sodium Chloride 0.45 %) (0.9 % Sodium Chloride) (Sodium Chloride 3 %) (Sodium Chloride 5 %) www.centersplan.com/fida/participants 181

sodium chloride intravenous parenteral solution 2.5 meq/ml, 4 meq/ml sodium lactate intravenous parenteral solution 167 meq/l sodium lactate intravenous solution 5 meq/ml sodium phosphate intravenous solution 3 mmol/ml TPN ELECTROLYTES II IV SOLN 25'S,20ML/50ML FTV 18-18-5-4.5-35 MEQ/20 ML TPN ELECTROLYTES INTRAVENOUS SOLUTION 35-20-5 MEQ/20 ML virt-phos 250 neutral oral tablet 250 mg v-r calcium 400 + d 133 caplet 400-133.3 mg-unit * Respiratory Tract Agents Anti-Inflammatories, Inhaled Corticosteroids ADVAIR DISKUS INHALATION BLISTER WITH DEVICE 100-50 MCG/DOSE, 250-50 MCG/DOSE, 500-50 MCG/DOSE ADVAIR HFA INHALATION HFA AEROSOL INHALER 115-21 MCG/ACTUATION, 230-21 MCG/ACTUATION, 45-21 MCG/ACTUATION BREO ELLIPTA INHALATION BLISTER WITH DEVICE 100-25 MCG/DOSE, 200-25 MCG/DOSE DULERA INHALATION HFA AEROSOL INHALER 100-5 MCG/ACTUATION, 200-5 MCG/ACTUATION (Sodium Chloride) (Sodium Lactate) (Sodium Lactate) (Sodium Phos,M- Basic-D-Basic) (K-Phos Neutral) (Caltrate 600 + D) QL (60 per 30 days) QL (12 per 28 days) QL (60 per 30 days) QL (13 per 28 days) www.centersplan.com/fida/participants 182

FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION FLOVENT DISKUS INHALATION BLISTER WITH DEVICE 250 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL INHALER 110 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL INHALER 220 MCG/ACTUATION FLOVENT HFA INHALATION HFA AEROSOL INHALER 44 MCG/ACTUATION QVAR INHALATION AEROSOL 40 MCG/ACTUATION, 80 MCG/ACTUATION Antileukotrienes montelukast oral granules in packet 4 mg (Singulair) montelukast oral tablet 10 mg (Singulair) montelukast oral tablet,chewable 4 (Singulair) mg, 5 mg zafirlukast oral tablet 10 mg, 20 mg (Accolate) Bronchodilators albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 5 mg/ml albuterol sulfate oral syrup 2 mg/5 ml albuterol sulfate oral tablet 2 mg, 4 mg albuterol sulfate oral tablet extended release 12 hr 4 mg, 8 mg (Albuterol Sulfate) (Albuterol Sulfate) (Albuterol Sulfate) (Vospire ER) QL (60 per 30 days) QL (120 per 30 days) QL (12 per 28 days) QL (24 per 28 days) QL (21.2 per 28 days) QL (17.4 per 25 days) www.centersplan.com/fida/participants 183

ATROVENT HFA INHALATION HFA AEROSOL INHALER 17 MCG/ACTUATION COMBIVENT RESPIMAT INHALATION MIST 20-100 MCG/ACTUATION ipratropium bromide inhalation solution 0.02 % ipratropium-albuterol inhalation solution for nebulization 0.5 mg-3 mg(2.5 mg base)/3 ml metaproterenol oral syrup 10 mg/5 ml metaproterenol oral tablet 10 mg, 20 mg PROAIR HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION PROAIR RESPICLICK INHALATION AEROSOL POWDR BREATH ACTIVATED 90 MCG/ACTUATION SEREVENT DISKUS INHALATION BLISTER WITH DEVICE 50 MCG/DOSE SPIRIVA RESPIMAT INHALATION MIST 1.25 MCG/ACTUATION, 2.5 MCG/ACTUATION SPIRIVA WITH HANDIHALER INHALATION CAPSULE, W/INHALATION DEVICE 18 MCG STRIVERDI RESPIMAT INHALATION MIST 2.5 MCG/ACTUATION terbutaline oral tablet 2.5 mg, 5 mg (Ipratropium Bromide) (Ipratropium/Albut erol Sulfate) (Metaproterenol Sulfate) (Metaproterenol Sulfate) (Terbutaline Sulfate) QL (25.8 per 28 days) QL (8 per 30 days) www.centersplan.com/fida/participants 184

terbutaline subcutaneous solution 1 mg/ml theochron oral tablet extended release 12 hr 100 mg, 200 mg, 300 mg theophylline in dextrose 5 % intravenous parenteral solution 200 mg/100 ml, 200 mg/50 ml, 400 mg/250 ml, 400 mg/500 ml, 800 mg/250 ml theophylline oral solution 80 mg/15 ml theophylline oral tablet extended release 12 hr 100 mg, 200 mg, 300 mg, 450 mg theophylline oral tablet extended release 400 mg, 600 mg TUDORZA PRESSAIR INHALATION AEROSOL POWDR BREATH ACTIVATED 400 MCG/ACTUATION, 400 MCG/ACTUATION (30 ACTUAT) VENTOLIN HFA INHALATION HFA AEROSOL INHALER 90 MCG/ACTUATION Respiratory Tract Agents, Other acetylcysteine intravenous solution 200 mg/ml (20 %) acetylcysteine solution 100 mg/ml (10 %), 200 mg/ml (20 %) CINQAIR INTRAVENOUS SOLUTION 10 MG/ML cromolyn inhalation solution for nebulization 20 mg/2 ml cromolyn sodium nasal spray 5.2 mg/spray (4 %) * DALIRESP ORAL TABLET 500 MCG (Terbutaline Sulfate) (Theophylline Anhydrous) (Theophylline/D5 W) (Theophylline Anhydrous) (Theophylline Anhydrous) (Theophylline Anhydrous) (Acetadote) (Acetadote) (Cromolyn Sodium) (Nasalcrom) QL (2 per 28 days) PA QL (30 per 30 days) www.centersplan.com/fida/participants 185

ESBRIET ORAL CAPSULE 267 MG KALYDECO ORAL GRANULES IN PACKET 50 MG, 75 MG KALYDECO ORAL TABLET 150 MG NUCALA SUBCUTANEOUS RECON SOLN 100 MG OFEV ORAL CAPSULE 100 MG, 150 MG ORKAMBI ORAL TABLET 200-125 MG PROLASTIN-C INTRAVENOUS RECON SOLN 1,000 MG sodium chloride 0.9% inhal vl u-d, suv, p/f (rx) 0.9 % * XOLAIR SUBCUTANEOUS RECON SOLN 150 MG (Pulmosal) 3 $0 Skeletal Muscle Relaxants Skeletal Muscle Relaxants baclofen oral tablet 10 mg, 20 mg (Baclofen) carisoprodol oral tablet 250 mg, 350 mg chlorzoxazone oral tablet 500 mg (Soma) (Parafon Forte DSC) PA; QL (270 per 30 days) PA; QL (60 per 30 days) PA; QL (60 per 30 days) PA; LA; QL (1 per 28 days) PA PA; QL (120 per 30 days) cyclobenzaprine oral tablet 10 mg, 5 PA-HRM (Fexmid) mg dantrolene oral capsule 100 mg, 25 mg, 50 mg (Dantrium) metaxall oral tablet 800 mg (Skelaxin) PA-HRM metaxalone oral tablet 400 mg, 800 PA-HRM (Skelaxin) mg methocarbamol oral tablet 500 mg, PA-HRM (Robaxin) 750 mg revonto intravenous recon soln 20 mg tizanidine oral capsule 2 mg, 4 mg, 6 mg (Zanaflex) www.centersplan.com/fida/participants 186 PA PA-HRM; QL (120 per 30 days) PA-HRM

tizanidine oral tablet 2 mg, 4 mg (Zanaflex) Sleep Disorder Agents Sleep Disorder Agents BELSOMRA ORAL TABLET 10 MG, 15 MG, 20 MG, 5 MG eszopiclone oral tablet 1 mg, 2 mg, 3 mg (Lunesta) HETLIOZ ORAL CAPSULE 20 MG NUVIGIL ORAL TABLET 150 MG, 200 MG, 250 MG, 50 MG ROZEREM ORAL TABLET 8 MG XYREM ORAL SOLUTION 500 MG/ML zaleplon oral capsule 10 mg, 5 mg (Sonata) zolpidem oral tablet 10 mg, 5 mg (Ambien) QL (30 per 30 days) PA-HRM; QL (30 per 30 days) PA PA LA PA-HRM; (High Risk Med. QL applies to all participants; PA required for 65 years and older with over 90 days cumulative use with any nonbenzodiazepine hypnotic drug); QL (60 per 30 days) PA-HRM; (High Risk Med. QL applies to all participants; PA required for 65 years and older with over 90 days cumulative use with any nonbenzodiazepine hypnotic drug); QL (30 per 30 days) www.centersplan.com/fida/participants 187

zolpidem oral tablet,ext release multiphase 12.5 mg, 6.25 mg Vasodilating Agents Vasodilating Agents (Ambien CR) ADCIRCA ORAL TABLET 20 MG ADEMPAS ORAL TABLET 0.5 MG, 1 MG, 1.5 MG, 2 MG, 2.5 MG epoprostenol (glycine) intravenous recon soln 0.5 mg, 1.5 mg LETAIRIS ORAL TABLET 10 MG, 5 MG (Flolan) OPSUMIT ORAL TABLET 10 MG ORENITRAM ORAL TABLET EXTENDED RELEASE 0.125 MG, 0.25 MG, 1 MG, 2.5 MG REMODULIN INJECTION SOLUTION 1 MG/ML, 10 MG/ML, 2.5 MG/ML, 5 MG/ML sildenafil intravenous solution 10 mg/12.5 ml (Revatio) sildenafil oral tablet 20 mg (Revatio) TRACLEER ORAL TABLET 125 MG, 62.5 MG TYVASO INHALATION SOLUTION FOR NEBULIZATION 1.74 MG/2.9 ML (0.6 MG/ML) PA-HRM; (High Risk Med. QL applies to all participants; PA required for 65 years and older with over 90 days cumulative use with any nonbenzodiazepine hypnotic drug); QL (30 per 30 days) PA; QL (60 per 30 days) PA; QL (90 per 30 days) PA; QL (30 per 30 days) PA; QL (30 per 30 days) PA PA; QL (37.5 per 1 day) PA; QL (90 per 30 days) PA; LA; QL (60 per 30 days) www.centersplan.com/fida/participants 188

TYVASO REFILL KIT INHALATION SOLUTION FOR NEBULIZATION 1.74 MG/2.9 ML (0.6 MG/ML) TYVASO STARTER KIT INHALATION SOLUTION FOR NEBULIZATION 1.74 MG/2.9 ML UPTRAVI ORAL TABLET 1,000 MCG, 1,200 MCG, 1,400 MCG, 1,600 MCG, 400 MCG, 600 MCG, 800 MCG UPTRAVI ORAL TABLET 200 MCG UPTRAVI ORAL TABLETS,DOSE PACK 200 MCG (140)- 800 MCG (60) Vitamins And Minerals Vitamins And Minerals a thru z advanced formula tab gluten-free 18-400 mg-mcg * a thru z advanced formula tab new formula * a thru z select 50+ formula tb advanced formula 0.4-300-250 mgmcg-mcg * a thru z select men 50+ tablet 300-600-300 mcg * a thru z select multivit tab 500-300- 250 mcg * a thru z select tablet adults 50+,iron-free 0.4-300-250 mg-mcgmcg * a thru z select tablet new formulation * a thru z select women's tablet * abc plus tablet 0.4-300-250 mgmcg-mcg * (Multivitamin/Iron/ Folic Acid) (Multivitamin with Minerals/Lut) (Biocel) (Biocel) (Biocel) (Biocel) (Multivitamin with Minerals/Lut) (Mv,Fe,Min/Lutein ) (Biocel) PA; QL (60 per 30 days) PA; QL (240 per 30 days) PA; QL (200 per 365 days) www.centersplan.com/fida/participants 189

adult multi gummies 200 mcg * (One-A-Day Vitacraves) adult one daily gummies 200 mcg * (One-A-Day Vitacraves) adults' 50+ daily formula tab 0.4-300-250 mg-mcg-mcg * (Biocel) adults 50+ multivitamin tablet 0.4-300-250 mg-mcg-mcg * (Biocel) adults' daily formula tablet 18-400 (Multivitamin/Iron/ mg-mcg * Folic Acid) animal chews tablet * (Multivitamin) antioxidant softgel softgel * (Beta-Carotene(A) W-C and E/Min) apatate forte liquid * (Multivitamin with Minerals) b complete tablet * (Vitamin B Complex) b complex capsule * (Vitamin B Complex) b complex formula #1 tablet * (Vitamin B Complex) b complex tablet * (Vitamin B Complex) b-12 500 mcg tablet 500 mcg * (B-12) b-12 dots 500 mcg tablet 500 mcg * (B-12) balance b-100 tablet * (Vitamin B Complex) balance b-50 tablet * (Vitamin B Complex) balance b-50 tablet inner,p/f,gluten/f (Vitamin B * Complex) balanced b-100 tablet * (Vitamin B Complex) balanced b-100 tablet 100 mg * (Vit B Complex 100 No.3/Herbal) balanced b-50 tablet * (Vitamin B Complex) www.centersplan.com/fida/participants 190

balanced b-50 tablet * (Vitamin B Complex) balanced b-complex caplet p/f,nolactose 400 mcg * (Dialyvite 800) b-complex plus vitamin c cplt caplet * (Vita-Bee with C) b-complex with b12 tablet * (Vitamin B Complex) b-complex with c tablet * (Vita-Bee with C) b-complex with vit c caplet s/f,p/f,gluten-free 400 mcg * (Dialyvite 800) biosupp liquid * (Multivitamin with Minerals) biotin 300 mcg tablet 300 mcg * (Biotin) biovol syrup * (Multivitamin with Minerals) c complex 1,000 mg tablet sa 1,000 mg * (Ascorbic Acid) c complex 500 mg tablet sa 500 mg * (Ascorbic Acid) calcidol drops 8,000 unit/ml * (Drisdol) centamin liquid 9 mg iron/15 ml * (Multivit- Minerals/Ferrous Gluc) central-vite seniors tablet * (Multivit with Iron- Minerals) centram-care multivit-min liq 9 mg iron/15 ml * centravites 50 plus tablet * centrum complete multivit tab 18-400 mg-mcg * centrum multivit-mineral liq 9 mg iron/15 ml * centrum silver tablet adults 50 + 0.4-300-250 mg-mcg-mcg * (Multivit- Minerals/Ferrous Gluc) (Multivit with Iron- Minerals) (Multivitamin/Iron/ Folic Acid) (Multivit- Minerals/Ferrous Gluc) (Biocel) www.centersplan.com/fida/participants 191

century adults 50+ tablet gluten free 0.4-300-250 mg-mcg-mcg * century mature tablet * cerovite liquid 9 mg iron/15 ml * certavite sr-antioxidant tab 0.4-300- 250 mg-mcg-mcg * certavite-antioxidant liquid 9 mg iron/15 ml * certavite-antioxidant tablet 18-400 mg-mcg * child chew + iron tab chew * (Biocel) century ultimate women's tab 18-400 mg-mcg * cerovite advanced form tab 18-400 mg-mcg * (Multivitamin with Minerals/Lut) (Multivitamin/Iron/ Folic Acid) (Multivitamin/Iron/ Folic Acid) (Multivit- Minerals/Ferrous Gluc) (Biocel) (Multivit- Minerals/Ferrous Gluc) (Multivitamin/Iron/ Folic Acid) (Multivitamin with Iron) child chew vitamin tablet * (Multivitamin) child ferrous sulfate 15 mg/ml 15 mg iron (75 mg)/ml * (Fer-In-Sol) children's chewable vitamin * (Multivitamin) childrens multivit tab chew * (Multivitamin) complete multi 50+ tablet 500-300- 250 mcg * (Biocel) complete multivitamin tab * (Multivit,Th Iron,Other Min) complete senior tablet * (Multivit with Iron- Minerals) cvs bal b-100 tablet * (Vitamin B Complex) cvs bal b-50 tablet * (Vitamin B Complex) cvs balanced b-150 tablet * (Vitamin B Complex) cvs b-complex-vit c caplet caplet * (Vita-Bee with C) www.centersplan.com/fida/participants 192

cvs child vit-mineral tab * (Multivit with Iron- Minerals) cvs children's chewable vit * (Multivitamin) cvs childs vit with c tab chew * (Multivitamin) cvs child's vitamin-iron tb * (Multivitamin with Iron) cvs daily gummies complete adult vit (One-A-Day 200 mcg * Vitacraves) cvs daily multiple tablet * (Multivitamin) cvs daily multiple tablet for women * (Multivitamin) cvs daily teen multi-vitamin 18-400 (Multivitamin/Iron/ mg-mcg * Folic Acid) cvs gummy swirls chewable * (Multivitamin) cvs hair, skin & nails tablet (Multivitamin with w/antioxidants * Minerals) cvs iron 27 mg tablet 240 mg (27 mg (Fergon) iron) * cvs men's daily gummies p/f, glutenfree 200 mcg * Vitacraves) (One-A-Day cvs men's multi-vit tablet * (Multivitamin) cvs prenatal vitamin tablet * (Prenatal Vit Calc,Iron,Folic) cvs spectravite adult 50+ tabs 0.4-300-250 mg-mcg-mcg * (Biocel) cvs spectravite advanced tab 18-400 (Multivitamin/Iron/ mg-mcg * Folic Acid) cvs spectravite liquid * (Pediavit) cvs spectravite senior * (Multivitamin with Minerals/Lut) cvs spectravite senior tab * (Multivit with Iron- Minerals) cvs spectravite senior tablet 500-300-250 mcg * (Biocel) cvs spectravite tablet chew * (Multivitamin with Iron) cvs spectravite ultra women tb 18-400 mg-mcg * (Multivitamin/Iron/ Folic Acid) www.centersplan.com/fida/participants 193

cvs super b complx & c cplt caplet, (Vita-Bee with C) p/f * cvs vision formula tablet 1,000 unit- (Vit A,C and 200 mg-60 unit-2 mg * E/Lutein/Minerals) (Vitamin B cvs vitamin b-100 complx tb * Complex) cvs vitamin c 1,000 mg tb chw 1,000 (Ascorbic Acid) mg * cvs vitamin d3 1,000 unit sfgl softgel (D3-50) 1,000 unit * cvs women's daily gummies p/f, (One-A-Day gluten-free 200 mcg * Vitacraves) cyanocobalamin 1,000 mcg/ml 25's (Cyanocobalamin 3 $0 1,000 mcg/ml * (Vitamin B-12)) d3 dots 2,000 unit tablet p/f 2,000 (Vitamin D3) unit * (Multivitamin with daily multi vitamin-iron tab * Iron) daily multiple tablet 18-400 mg-mcg (Multivitamin/Iron/ * Folic Acid) daily multiple vitamin tab sugar (Multivitamin) coated * daily value multivitamin tab s/f * (Multivitamin) (Multivitamin with daily vitamin + iron tablet * Iron) daily vitamin formula tablet * (Multivitamin) (Multivitamin with daily vitamin formula tablet * Minerals) daily vitamin tablet p/f,na/f * (Multivitamin) daily vite tablet s/f, p/f * (Multivitamin) daily vite tablet s/f,p/f * (Multivitamin) (Multivitamin with daily vite with iron tablet * Iron) dino-life extra c tab chew * (Multivitamin) daily multivitamin-iron tablet 18- daily vit formula + iron tab 18-400 (Multivitamin/Iron/ (Multivitamin/Iron/ 400 mg-mcg * mg-mcg * Folic Acid) Folic Acid) www.centersplan.com/fida/participants 194

dino-life iron-zinc tb chew * (Multivit with Iron- Minerals) dino-life tablet chewable * (Multivitamin) eldertonic elixir 0.5-0.6-7-0.7 mg * (B1,B2,B3,B6,B12 /Dexpan/Zn/Mang) ellis tonic * (Multivitamin with Minerals) (Pedi Mv eq child complete chew tablet 18 mg No.58/Ferrous iron * Fumarate) eq complete multivitamin tab 0.4-300-250 mg-mcg-mcg * (Biocel) eq complete multivitamin tab glutenfree 18-400 mg-mcg * Folic Acid) (Multivitamin/Iron/ eql central-vite select tablet * (Multivitamin with Minerals/Lut) eql century mature tablet 500-300- 250 mcg * (Biocel) eql chewable multi vitamin tab * (Multivitamin) eql child's multivit tab chew with vitamin c * (Multivitamin) eql childs multivit-mineral tb * (Multivit with Iron- Minerals) eql one daily 50 plus tablet * (Multivitamin with Minerals) eql one daily essential tablet * (Multivitamin) eql one daily maximum tablet 18-0.4 mg * (Tab A Vite) eql one daily men's tablet * (Multivitamin with Minerals) eql vision formula tablet * (Beta-Carotene(A) W-C and E/Min) ergocalciferol 8,000 units/ml 8,000 unit/ml * (Drisdol) essentia tablet 18-400 mg-mcg * (Multivitamin/Iron/ Folic Acid) essential balance tablet * (Mv,Fe,Min/Lutein ) www.centersplan.com/fida/participants 195

essential daily tablet w/iron & calcium 18-0.4 mg * ferocon capsule 110-0.5 mg * ferretts 325 mg tablet 325 mg (106 mg iron) * ferrex 150 capsule outer, u-d 150 mg iron * ferrex 150 plus capsule 150-50-50 mg * (Tab A Vite) (Fe Fumarate/Vit C/B12-If/Fa) 3 $0 (Ferrous Fumarate) (Iron Polysaccharide Complex) (Iron Aspgly,Ps/C/Succi nic Acid) ferrocite tablet 324 mg (106 mg iron) * (Ferrous Fumarate) ferrous fumarate 324 mg tab 324 mg (Ferrous Fumarate) (106 mg iron) * ferrous gluconate 240 mg tab 240mg=27mg elemental 240 mg (27 (Fergon) mg iron) * ferrous gluconate 324 mg tab 324 mg (36 mg iron), 324 mg (38 mg (Fergon) iron) * ferrous gluconate 325 mg tab p/f,s/f,gluten-free 325 mg (36 mg iron) * (Fergon) ferrous sulf 220 mg/5 ml elix 220 mg (Ferrous Sulfate) (44 mg iron)/5 ml * ferrous sulf 300 mg/5 ml liq 300 mg (60 mg iron)/5 ml * (Ferrous Sulfate) ferrous sulf ec 324 mg tablet 324 mg (Ferrous Sulfate) (65 mg iron) * ferrous sulfate 325 mg tablet red 325 mg (65 mg iron) * (Ferrous Sulfate) flintstones complete tablet * (Multivit with Iron- Minerals) flintstones extra c tab chew * (Multivitamin) flintstones tablet chewable * (Multivitamin) www.centersplan.com/fida/participants 196

flintstones with iron tab chew 18 mg iron * (Pedi Mv No.79/Ferrous Fumarate) folic acid 1 mg tablet (rx) 1 mg * (Folic Acid) 3 $0 folic acid 1,000 mcg tablet p/f,s/f (otc) 1 mg * (Folic Acid) FOLIC ACID 20 MG CAPSULE 20 MG * folic acid 400 mcg tablet s/f,p/f,lactose-free 400 mcg * (Folic Acid) fosfree tablet 175.5-14.5 mg * (Calcium/Multivita min with Iron) geravim liquid * (Pediavit) geriaton liquid * (Pediavit) gnp century mature tablet gluten- (Biocel) free 0.4-300-250 mg-mcg-mcg * gnp century tablet gluten-free 18- (Multivitamin/Iron/ 400 mg-mcg * Folic Acid) gnp one daily essential tablet * (Multivitamin) gs prenatal vitamins tablet 28-800 (Pnv133/Ferrous mg-mcg * Fumarate/Fa) gummi bear multivit tab chew (Multivitamin) multivit & minerals * hair vitamins * (Multivitamin with Iron) (Vit A,C and E/Lutein/Minerals) healthy eyes caplet caplet 1,000 unit-200 mg-60 unit-2 mg * hemocyte tablet u-u,blister pk 324 mg (106 mg iron) * (Ferrous Fumarate) hi-b complex tablet * (Vitamin B Complex) hm complete 50+ tablet 0.4-300-250 (Biocel) mg-mcg-mcg * hm one daily with iron tablet glutenfree 18-400 mg-mcg * Folic Acid) (Multivitamin/Iron/ hm super vitamin b complex glutenfree 400 mcg * (Dialyvite 800) honey bears chew tab * (Multivitamin) www.centersplan.com/fida/participants 197

honey bears-iron-zinc tab chew * (Multivit with Iron- Minerals) icaps plus tablet lactose free * (Multivitamin with Minerals) iferex 150 capsule 150 mg iron * (Iron Polysaccharide Complex) iron 27 mg tablet 236 mg (27 mg iron) * (Fergon) iron 28 mg tablet 256 mg (28 mg iron) * (Fergon) kenwood therapeutic liquid * (Multivitamin,Ther apeutic) life-pack women's p/f,s/f 0.8 mg * (Multivit with Iron- Minerals) LIQUI-E LIQUID 400 UNIT/15 ML * little animals child tb chw * (Multivitamin) little animals-iron tab chew * (Multivitamin with Iron) lysiplex plus liquid * (Pediavit) MACUVITE EYE CARE TABLET 7,160 UNIT-113 MG-100 UNIT * MACUVITE TABLET 5,000-60-30 UNIT-MG-UNIT * mega multivitamin-mineral tab * (Multivitamin with Minerals) mega multivit-chelated min tab * (Multivitamin with Minerals) MEPHYTON 5 MG TABLET 5 MG * 3 $0 milltrium senior multivit tab * (Multivitamin with Minerals/Lut) multi complete-iron tablet 18-400 (Multivitamin/Iron/ mg-mcg * multi-day plus iron tablet 18-400 mg-mcg * Folic Acid) (Multivitamin/Iron/ Folic Acid) www.centersplan.com/fida/participants 198

multi-delyn with iron liquid 10 mg (Multivitamin/Ferr iron/5 ml * ous Gluconate) multiple vitamin with iron tab * (Multivitamin with Iron) multiple vitamin w-minerals tb * (Multivitamin with Minerals) multiple vitamins tablet one daily * (Multivitamin) multivitamin child tab chew * (Multivitamin) multi-vitamin daily tablet * (Multivitamin) multivitamin-mineral liquid 9 mg iron/15 ml * multivit-fluor 0.5 mg tab chew chewable, d/f, s/f 0.5 mg multivit-iron child tab chew children's * multivit-mineral hp cap * multivit-minerals tablet s/f,p/f * (Multivit- Minerals/Ferrous Gluc) (Pedi M.Vit No.17 with Fluoride) (Multivitamin with Iron) (Multivitamin,Ther and Minerals) (Multivitamin with Minerals) my favorite multiple liquid * (Multivitamin) myvitalife soft-gel capsule * (Multivitamin with Minerals) NASCOBAL 500 MCG NASAL SPRAY 500 MCG/SPRAY * nephplex rx tablet 1-60-300-12.5 mg-mg-mcg-mg * nephron fa tablet 66.6-75-1 mg * nephro-vite rx tablet 1-60-300 mgmg-mcg * niacinamide er 500 mg tablet 500 mg * nu-iron 150 capsule 150 mg iron * (Vit B Cmplx No3/Fa/C/Biot/Zin c) (Fe Fumarate/Doss/Fa/ Bcomp,C) (Vit B Cmplx 3/Fa/Vit C/Biotin) 3 $0 3 $0 3 $0 3 $0 (Niacinamide) (Iron Polysaccharide Complex) www.centersplan.com/fida/participants 199

ocutabs tablet s/f, w/lutein * (Beta-Carotene(A) W-C and E/Min) oncovite tablet * (Multivitamin,Ther apeutic) one daily complete tablet * (Multivitamin with Minerals) one daily essential tablet * (Multivitamin) one daily multivitamin tab * (Multivitamin) one daily multivitamin tablet * (Multivitamin with Iron) one daily multivitamin tablet 400 mcg * (Quintabs) one daily multivitamin-iron tb 18- (Multivitamin/Iron/ 400 mg-mcg * Folic Acid) one daily plus iron tablet 18-400 (Multivitamin/Iron/ mg-mcg * Folic Acid) one daily tablet * (Multivitamin) one daily tablet * (Multivitamin with Iron) one daily tablet men's formula * (Multivitamin) one daily with minerals tablet * (Multivitamin with Minerals) one-a-day essential tablet * (Multivitamin) one-a-day max formula tab * (Multivitamin with Minerals) one-a-day teen advantage tab 18- (Multivitamin/Iron/ 400 mg-mcg * Folic Acid) one-a-day teen advantage tab 9 mg (Multivits,Ca,Mine iron-400 mcg * rals/iron/fa) pharmacist multi-vite tab * (Multivitamin) pnv prenatal plus multivit tab s/f, (Pnv with gluten-free 27 mg iron- 1 mg Ca,No.72/Iron/Fa) (Iron poly-iron 150 mg capsule 150 mg Polysaccharide iron * Complex) poly-vita drops 1,500-35-400 unitmg-unit/ml * (Pediatric Multivitamin No.20) (All Rx Prenatal Vitamins Covered) www.centersplan.com/fida/participants 200

poly-vita with iron drops 1,500 unit- (Ped Multivit 400 unit-10 mg/ml * #46/Iron Sulfate) (Pediatric poly-vitamin drops 1,500-35-400 Multivitamin unit-mg-unit/ml * No.20) poly-vitamin tab chew * (Multivitamin) polyvitamin w-iron drops 1,500 (Ped Multivit unit-400 unit-10 mg/ml * #46/Iron Sulfate) (Prenatal Vit prenatal tablet (otc) 27-0.8 mg * No.130/Iron/Fa) (Prenatal prenatal tablet 27 mg iron- 800 mcg Vit#96/Ferrous * Fum/Fa) prenatal tablet 28 mg iron- 800 mcg (Prenatal Vit/Iron * Fumarate/Fa) prenatal vitamins tablet phosphorus (Prenatal) free 28 mg iron- 800 mcg * (Multivitamin with pub multivitamin 50 plus tab * Minerals/Lut) (Vitamin B pv b-100 complex * Complex) (Vitamin B pv b-50 complex * Complex) pv kid's gummy bear tab chew (Multivitamin) chewable * pv kid's vit + extra c chew tb * (Multivitamin) (Multivitamin with pv kid's vit + iron tab chew * Iron) pv kid's vit complete tab chew * (Multivitamin) pv kid's vitamins chew tab * (Multivitamin) prenatal vitamin plus low iron oral prenatal vitamin tablet 28 mg ironprosight tablet 5,000-60-30 unit-mgunit * (Pnv with (Prenatal Vit/Iron (A/C/E/Zinc/Sod tablet 27 mg iron- 1 mg 800 mcg * Ca,No.72/Iron/Fa) Fumarate/Fa) Selenate/Copper) pv kids vitamins+iron tab chew 15 mg iron * (Ped Multivit #17/Iron Fumarate) (All Rx Prenatal Vitamins Covered) www.centersplan.com/fida/participants 201

pv multivital platinum tablet * pv multivital platinum tablet w/lutein & lycopene 500-300-250 mcg * pv prenatal formula tablet 28 mg iron- 800 mcg * pv stress 500 plus zinc tab * pyridoxine 100 mg/ml vial 100 mg/ml * qc child complete vit chew tab 18 mg iron * (Multivitamin with Minerals/Lut) (Biocel) (Prenatal Vit No.131/Iron/Fa) (Multivitamin,Stres s Formula/Zn) (Pyridoxine HCl) 3 $0 (Pedi Mv No.67/Ferrous Fumarate) qc children's chewable tablet * (Multivitamin) qc maximum daily multivit tab 18- (Tab A Vite) 0.4 mg * qc multi-vite 50 & over tablet (Multivitamin with w/lycopene * Minerals/Lut) qc multi-vite tablet 18-400 mg-mcg (Multivitamin/Iron/ * Folic Acid) qc women's daily multivit tab 18-0.4 (Tab A Vite) mg * (Vitamin B ra balanced b-100 tablet 0.4 mg * Complex/Folic Acid) (Vitamin B ra b-complex tablet p/f * Complex) (Vitamin B ra b-complex tablet p/f * Complex) (Multivitamin with ra central vite select tab p/f * Minerals/Lut) (Multivit with Ironra central-vite select tab p/f * Minerals) ra central-vite senior tablet 0.4-300- (Biocel) 250 mg-mcg-mcg * ra central-vite tablet 0.4-300-250 (Biocel) mg-mcg-mcg * www.centersplan.com/fida/participants 202

ra central-vite tablet 18-400 mgmcg * Folic Acid) (Multivitamin/Iron/ ra one daily energy tablet * (Multivitamin with Minerals) ra one daily plus iron tablet * (Multivitamin with Iron) ra one daily tablet p/f * (Multivitamin) ra prenatal tablet 28 mg iron- 800 (Prenatal Vit/Iron mcg * Fumarate/Fa) ra therapeutic m multivit tab 18-0.4 mg * (Tab A Vite) ra vit b-12 1,000 mcg/ml liq 1,000 (Cyanocobalamin mcg/ml * (Vitamin B-12)) ra vitamin c 1,000 mg tab sa w/bioflavonoids 1,000 mg * (Ascorbic Acid) ra vitamin c 500 mg tab chew p/f 500 mg * (Ascorbic Acid) ra vitamin c tr 500 mg caplet caplet,p/f,s/f 500 mg * (Ascorbic Acid) rena-vite rx tablet 1-60-300 mg-mgmcg * 3/Fa/Vit C/Biotin) (Vit B Cmplx 3 $0 scooby-doo one a day tablet * (Multivit with Iron- Minerals) senior tabs 0.4-300-250 mg-mcgmcg * (Biocel) sentry senior multivitamin tab sodium/f,yeast/f 500-300-250 mcg * (Biocel) sentry senior tablet 0.4-300-250 mgmcg-mcg * (Biocel) sentry tablet 18-400 mg-mcg * (Multivitamin/Iron/ Folic Acid) (Vit A,C, and sm airshield effervescent tab 5,000- E/Dietary Supp 1000-30 unit-mg-unit * No.12) sm animal shapes tab chew * (Multivitamin) sm animal shapes tab chew toddlers * (Multivitamin) www.centersplan.com/fida/participants 203

sm animal shapes w-iron tab children's * sm antioxidant vitamins tablet 1,000 unit-200 mg-60 unit-2 mg * sm b complex with vit c tablet gluten-free * sm complete multi-vit-mineral advanced formula 18-400 mg-mcg * sm complete senior formula tab * sm complete senior formula tab 0.4-300-250 mg-mcg-mcg * sm multivitamin w-iron tab * sm natural balanced b-100 tab 100 mg * sm opti-vitamin tablet 1,000 unit- 200 mg-60 unit-2 mg * sm prenatal vitamins tablet 28 mg iron- 800 mcg * sm super b complex-c caplet caplet * sm therapeutic m tablet 27-0.4 mg * sm vitamin b complex tablet glutenfree 0.4 mg * sm vitamin b-100 complex tab gluten-free 0.4 mg * sm vitamin d3 4,000 unit sftgl softgel, gluten-free 4,000 unit * sodium fluoride 1 mg (2.2 mg) 1 mg fluoride (2.2 mg) sodium fluoride oral tablet 1 mg fluoride (2.2 mg) (Multivitamin with Iron) (Vit A,C and E/Lutein/Minerals) (Vita-Bee with C) (Multivitamin/Iron/ Folic Acid) (Multivit with Iron- Minerals) (Biocel) (Multivitamin with Iron) (Vit B Complex 100 Cmb #2/Herbs) (Vit A,C and E/Lutein/Minerals) (Prenatal) (Vita-Bee with C) (Multivit,Tx,Iron/C alcm/fa/mins) (Vitamin B Complex/Folic Acid) (Vitamin B Complex/Folic Acid) (D3-50) (Sodium Fluoride) (Pedi M.Vit No.17 with Fluoride) www.centersplan.com/fida/participants 204

stress b tablet * (Vitamin B Complex) stress b with zinc tablet * (Multivitamin,Stres s Formula/Zn) stress formula tablet * (Multivitamin,Stres s Formula) stress formula with iron tab * (Iron/Mv,Stress Form) (Vit B stress formula with iron tab 500 mg- Comp/C/Fa/Iron/Vi 400 mcg- 18 mg iron * t E) stress formula with zinc tab * (Multivitamin,Stres s Formula/Zn) (Vit B stress-c with iron tablet 500 mg-400 Comp/C/Fa/Iron/Vi mcg- 18 mg iron * t E) (Mv-Min/Iron sunvite tablet 18 mg iron-400 mcg- Fum/Fa/K/Lyco/Lu 25 mcg * tn) super b complex-c caplet caplet * (Vita-Bee with C) (Vitamin B super b maxi complex caplet 0.4 mg Complex/Folic * Acid) super b with vit c capsule * (B Complex with Vitamin C) super b-50 complex capsule * (Vitamin B Complex) super b-50 complex plus tab * super b-complex folic-vit c tb p/f 400 mcg * (Vitamin B Complex) (Dialyvite 800) super multiple vit-mineral tab * (Multivit with Iron- Minerals) super multivitamin tablet * (Multivitamin) super quints b-50 tablet 0.4 mg * (Vitamin B Complex/Folic Acid) www.centersplan.com/fida/participants 205

super quints b-50 tablets * (Vitamin B Complex) super thera vite m tablet * (Multivitamin,Ther and Minerals) superior 35 vit-mineral tab sa * (Multivit with Iron- Minerals) superplex-t tablet * (Vita-Bee with C) support liquid * (Multivitamin with Minerals) support-500 softgel * (B Complex with Vitamin C) 3 $0 sv hair, skin & nails caplet 1 mg (Mv,Ca,Min/Iron iron-66.7 mcg-1,000 mcg * Gluc/Fa/Biotin) tab-a-vite tablet * (Multivitamin) tab-a-vite with iron tablet * (Multivitamin with Iron) tab-a-vite-minerals tablet * (Multivitamin with Minerals) thera m plus tablet 9 mg iron-400 (Multivits,Ca,Mine mcg * rals/iron/fa) thera tablet * (Multivitamin,Ther apeutic) thera-d 2000 tablet 2,000 unit * (Vitamin D3) theradex m tablet 27-0.4 mg * (Multivit,Tx,Iron/C alcm/fa/mins) thera-m caplet caplet 27-0.4 mg * (Multivit,Tx,Iron/C alcm/fa/mins) thera-m tablet w/beta carotene 9 mg (Multivits,Ca,Mine iron-400 mcg * rals/iron/fa) therapeutic-m caplet p/f, s/f, caplet 9 (Multivits,Ca,Mine mg iron-400 mcg * rals/iron/fa) thera-tabs tablet * (Multivitamin,Ther apeutic) theratrum compl 50 plus tab * (Multivitamin with Minerals/Lut) theratrum complete 50 plus (Multivit with Ironp/f,caplet * Minerals) www.centersplan.com/fida/participants 206

thiamine 200 mg/2 ml vial 25's,mdv,outer 100 mg/ml * (Thiamine HCl) 3 $0 thiamine 500 mg tablet 500 mg * (Thiamine HCl) total b with vit c caplet * (Vita-Bee with C) totalday multiple tablet sa * (Multivitamin with Minerals) (Vit A tri-vi-sol drops 750 unit-35 mg -400 Palmitate/Vit C/Vit unit/ml * D3) tri-vita drops 1,500-35-400 unit-mgunit/ml * tri-vitamin drops 1,500-35-400 unitmg-unit/ml * ultra b-100 complex tablet * v-c forte capsule 1 mg * vic-forte capsule 1 mg * vision plus lutein vitamin tab * vision vitamins * vision vitamins tablet w/lutein,p/f 1,000 unit-200 mg-60 unit-2 mg * vit d2 1.25 mg (50,000 unit) 50,000 unit * vitalets tablet chewable child, orange,s/f * vitamin a 10,000 units capsule soluble 10,000 unit * vitamin a 25,000 units capsule softgel 25,000 unit * vitamin and minerals tablet * (Pedi Multivits A,C, and D3 No.21) (Pedi Multivits A,C, and D3 No.21) (Vitamin B Complex) (Multivitamin- Minerals No.7/Fa) (Multivitamin- Minerals No.7/Fa) (Multivitamin with Minerals/Lut) (Beta-Carotene(A) W-C and E/Min) (Vit A,C and E/Lutein/Minerals) 3 $0 3 $0 (Drisdol) 3 $0 (Multivitamin with Iron) (Vitamin A) (Vitamin A) (Multivitamin,Ther and Minerals) www.centersplan.com/fida/participants 207

vitamin b complex tablet 500 mg- 400 mcg- 18 mg iron * vitamin b complex-vit c cap * (Vit B Comp/C/Fa/Iron/Vi t E) (B Complex with Vitamin C) vitamin b complex-vit c tablet * (Vita-Bee with C) vitamin b-12 1,000 mcg tablet 1,000 mcg * (B-12) vitamin b-12 100 mcg tablet 100 mcg * (B-12) vitamin b-12 250 mcg tablet 250 mcg * (B-12) vitamin b12 500 mcg tablet 500 mcg * (B-12) vitamin b12-folic acid tablet 500- (Cyanocobalamin/ 400 mcg * Folic Acid) vitamin b-6 250 mg tablet p/f 250 mg * (Pyridoxine HCl) vitamin b-6 50 mg tablet 50 mg * (Pyridoxine HCl) vitamin b-complex & c caplet p/f,no (Fa/Vit B Complex lactose,cplt 400-500 mcg-mg * and C/Rice Bran) vitamin c 1,000 mg tablet 1,000 mg * (Ascorbic Acid) vitamin c 1,500 mg tablet sa na/f,s/f,starch/free 1,500 mg * (Ascorbic Acid) vitamin c 250 mg tablet 250 mg * (Ascorbic Acid) vitamin c 250 mg tablet chew 250 mg * (Ascorbic Acid) vitamin c 500 mg/5 ml liquid 500 mg/5 ml * (Ascorbic Acid) vitamin d 1,000 unit tablet 1,000 unit * (Vitamin D3) vitamin d3 1,000 unit tablet s/f,p/f 1,000 unit * (Vitamin D3) vitamin d3 1,000 units softgel softgel, p/f, s/f 1,000 unit * (D3-50) vitamin d3 10,000 unit softgel softgel 10,000 unit * (D3-50) www.centersplan.com/fida/participants 208

vitamin d3 2,000 unit tablet s/f,p/f 2,000 unit * (Vitamin D3) vitamin d3 400 unit tab chew orange, p/f 400 unit * (Vitamin D3) vitamin d3 400 unit tablet s/f,p/f 400 unit * (Vitamin D3) vitamin d3 400 unit/5 ml liq 400 (Cholecalciferol unit/5 ml * (Vitamin D3)) vitamin d3 5,000 unit capsule s/f, p/f 5,000 unit * (D3-50) vitamin d3 5,000 unit/ml drops a/f, p/f,gluten-free 5,000 unit/ml * (Just D) vitamin k 100 mcg tablet p/f, glutenfree 100 mcg * (Phytonadione) vitamins for hair tablet * (Multivitamin) vitrum 50+ senior tablet 500-300- 250 mcg * (Biocel) vitrum senior tablet f/f,p/f * (Multivitamin with Minerals/Lut) v-r natural b-100 tablet * (Vitamin B Complex) yelets tablet 18-400 mg-mcg * (Multivitamin/Iron/ Folic Acid) zoo chews gummie tablet * (Multivitamin) www.centersplan.com/fida/participants 209

INDEX 3 3 day vaginal... 53 30pse-150gfn-15dm... 107 3-day vaginal... 50 8 8-MOP... 118 A a thru z advanced formula... 189 a thru z high potency... 189 a thru z select... 189 a thru z select 50+ formula... 189 a thru z select women's... 189 abacavir... 68, 69 abacavir-lamivudine-zidovudine... 69 abc plus... 189 ABELCET... 49 ABILIFY MAINTENA... 65 ABRAXANE... 28 ABREVA... 59 acamprosate... 14 acarbose... 45, 46 acebutolol... 87 acephen... 3 acetaminophen... 3 acetaminophen-codeine... 3 acetazolamide... 172 acetazolamide sodium... 172 acetic acid... 133, 165 acetylcysteine... 185 acid gone antacid... 139 acid reducer (famotidine)... 137, 138 acid relief (cimetidine)... 138 acitretin... 118 acne medication... 118, 120 ACNE MEDICATION... 118 acne-clear... 118 ACTEMRA... 166, 167 ACTHIB (PF)... 159 ACTIMMUNE... 167 actinel pediatric... 107 acyclovir... 74, 118 acyclovir sodium... 74 ADACEL(TDAP ADOLESN/ADULT)(PF) 159 ADAGEN... 127 adapalene... 125, 126 ADCETRIS... 28 ADCIRCA... 188 adefovir... 74 ADEMPAS... 188 adriamycin... 28 adrucil... 28 adt robitussin peak cld dm max... 107 adult multivitamin gummies 190 adult nasal decongestant... 114 adult one daily gummies... 190 adult robitussin lingering cld 107 adult robitussin peak cold dm... 107 adult wal-tussin... 107 adult wal-tussin dm max... 107 adults 50+... 190 adults 50+ daily formula... 190 adults' daily formula... 190 ADVAIR DISKUS... 182 ADVAIR HFA... 182 ADVIL... 10 af 50 afeditab cr... 92 AFINITOR... 28 AFINITOR DISPERZ... 28 AFTERA... 99 a-hydrocort... 152 airshield... 203 AKTEN (PF)... 129 AKYNZEO... 61 ala-cort... 122 ala-scalp... 122 alavert... 53 alavert d-12 allergy-sinus... 53 ALBENZA... 62 albuterol sulfate... 183 alcaine... 129 alclometasone... 122 ALCOHOL PADS... 118 ALCOHOL PREP PADS... 118 ALDURAZYME... 127 ALECENSA... 28 alendronate... 165 alfuzosin... 149 ALIMTA... 28 ALINIA... 63 alka-seltzer plus mucus-conges... 107 ALLEGRA ALLERGY... 53 aller-chlor... 54 allerclear d-12hr... 54 allerclear d-24hr... 54 allergy (chlorpheniramine)... 54 allergy (diphenhydramine)... 55 allergy relief (cetirizine)... 55 allerhist-1... 54 aller-tec d... 54 allopurinol... 167 ALLZITAL... 3 almacone... 139 almacone-2... 139 aloe vesta antifungal (micon). 49 I-1 www.centersplan.com/fida/participants

alophen... 144 alosetron... 164 ALPHAGAN P... 172 alprazolam... 16 ALREX... 135 altacaine... 129 altamist... 129 altavera (28)... 99 aluminum hydroxide gel... 139 alyacen 1/35 (28)... 99 alyacen 7/7/7 (28)... 99 amantadine hcl... 63 ambi 10peh-4cpm-20dm... 107 ambi 20dm-4cpm... 107 ambi 40pse-400gfn-20dm... 107 ambi 60pse-4cpm... 54 ambi 60pse-4cpm-20dm... 107 AMBISOME... 49 amethia... 99 amethia lo... 99 amifostine crystalline... 167 amiloride... 92 amiloride-hydrochlorothiazide92 AMINO ACIDS 15 %... 78 aminocaproic acid... 77 AMINOSYN 10 %... 78 AMINOSYN 3.5 %... 78 AMINOSYN 7 %... 78 AMINOSYN 7 % WITH ELECTROLYTES... 78 AMINOSYN 8.5 %... 78 AMINOSYN 8.5 %- ELECTROLYTES... 79 AMINOSYN II 10 %... 79 AMINOSYN II 15 %... 79 AMINOSYN II 7 %... 79 AMINOSYN II 8.5 %... 79 AMINOSYN II 8.5 %- ELECTROLYTES... 79 AMINOSYN M 3.5 %... 79 AMINOSYN-HBC 7%... 79 AMINOSYN-PF 10 %... 79 AMINOSYN-PF 7 % (SULFITE-FREE)... 79 AMINOSYN-RF 5.2 %... 79 amiodarone... 86 AMITIZA... 139 amitriptyline... 42 amlactin... 118 amlodipine... 92 amlodipine-atorvastatin... 93, 94 amlodipine-benazepril... 92 amlodipine-valsartan... 92 amlodipine-valsartan-hcthiazid... 92 ammonium lactate... 118 amoxapine... 42 amoxicil-clarithromy-lansopraz... 137 amoxicillin... 23 amoxicillin-pot clavulanate... 24 amphotericin b... 50 ampicillin... 24 ampicillin sodium... 24 ampicillin-sulbactam... 24 AMPYRA... 97 ANACAINE... 119 anagrelide... 77 anastrozole... 28 ANDRODERM... 150 ANDROGEL... 150 androxy... 150 animal chews... 190 animal shape vitamins... 203 animal shapes plus iron... 204 antacid anti-gas... 140 antacid anti-gas (ca carb-sim)... 140 antacid extra-strength... 139 antacid plus extra strength... 139 anticoag citrate phos dextrose... 167 anti-diarrheal... 141 anti-diarrheal (loperamide).. 140, 141 antifungal... 50 antifungal (tolnaftate)... 50, 53 anti-gas maximum strength.. 137 antioxidant... 190 antioxidant vitamins... 204 apatate forte... 190 APOKYN... 63 apraclonidine... 129 apri... 99 APRISO... 164 aprodine... 54 APTIOM... 37 APTIVUS... 69 aquanil hc... 122 aranelle (28)... 99 ARCALYST... 156 aripiprazole... 65 ARISTADA... 65 arthritis pain relief (acetam)... 9 artificial tears... 129 artificial tears (petro/min)... 129 artificial tears (pf)... 129 artificial tears (polyvin alc).. 129 artificial tears(glycerin-peg). 130 artificial tears(hypromellose) 132 ASACOL HD... 164 ascomp with codeine... 3 ascorbic acid (vitamin c)... 194, 208 ashlyna... 100 aspirin... 10, 11 aspirin, buffered... 11 aspirin-dipyridamole... 78 aspir-low... 11 ASSURE ID INSULIN SAFETY... 126 ASTAGRAF XL... 156 atenolol... 87 atenolol-chlorthalidone... 87 atorvastatin... 94 I-2 www.centersplan.com/fida/participants

atovaquone... 63 atovaquone-proguanil... 63 ATRIPLA... 69 atropine... 37, 129 atropine-care... 129 ATROVENT HFA... 184 AUBAGIO... 156 aubra... 100 AVASTIN... 28 AVC VAGINAL... 59 aviane... 100 AVONEX... 167 AVONEX (WITH ALBUMIN)... 167 ayr saline... 129 azacitidine... 28 azathioprine... 156 azathioprine sodium... 156 azelastine... 129, 130 AZILECT... 64 azithromycin... 22 AZOPT... 172 AZOR... 92 aztreonam... 23 azurette (28)... 100 B b complete... 190 b complex 1... 190 b complex 100... 204 b complex-vitamin b12... 191 b complex-vitamin c-folic acid... 191, 197, 205 b-100 complex... 201 b-12 dots... 190 b-50 complex... 201 bacitracin... 17, 120, 133 bacitracin-polymyxin b... 133 bacitraycin plus... 120 baclofen... 186 bal b-100... 192 bal b-50... 192 balance b-100... 190 balance b-50... 190 balanced b-100... 190, 202 balanced b-150... 192 balanced b-50... 190 balanced b-50 complex... 191 balsalazide... 164 balziva (28)... 100 banophen... 54 banophen allergy... 54 BANZEL... 37, 38 baza antifungal... 50 BCG VACCINE, LIVE (PF) 159 b-complex... 202 b-complex with vitamin c... 191, 192, 204, 208 BD INSULIN PEN NEEDLE UF SHORT... 127 BD INSULIN SYRINGE ULTRA-FINE... 126, 127 bekyree (28)... 100 BELBUCA... 3 BELEODAQ... 28 BELSOMRA... 187 benadryl allergy... 54 benazepril... 85 benazepril-hydrochlorothiazide... 85 BENDEKA... 29 BENICAR... 84 BENICAR HCT... 84 BENLYSTA... 167 benzonatate... 108 benzoyl peroxide... 119 benztropine... 64 BETADINE... 119 beta-hc... 122 betamethasone acet,sod phos 152 betamethasone dipropionate. 122 betamethasone valerate... 122 betamethasone, augmented.. 123 BETASERON... 167 betaxolol... 87, 172 bethanechol chloride... 167 BETHKIS... 16, 17 bexarotene... 29 BEXSERO (PF)... 159 bicalutamide... 29 bicarsim forte... 136 BICILLIN C-R... 24 BICILLIN L-A... 24 BIDIL... 96 bimatoprost... 172 bio-dtuss dmx... 108 bion tears (pf)... 130 bionel pediatric... 108 biospec dmx... 108 biosupp... 191 biotin... 191 biovol... 191 bisac-evac... 144 bisacodyl... 144 biscolax... 144 bismatrol... 140 bisoprolol fumarate... 87 bisoprolol-hydrochlorothiazide... 87 bleomycin... 29 bleph-10... 133 BLINCYTO... 29 blisovi 24 fe... 100 blisovi fe 1.5/30 (28)... 100 blisovi fe 1/20 (28)... 100 blis-to-sol (tolnaftate)... 50 BOOSTRIX TDAP... 159 BOSULIF... 29 bp 8 cough... 108 BREO ELLIPTA... 182 briellyn... 100 BRILINTA... 78 brimonidine... 172 BRINTELLIX... 42 BRIVIACT... 38 bromfed dm... 108 bromfenac... 135 I-3 www.centersplan.com/fida/participants

bromocriptine... 64 bromphenex dm... 108 brompheniramine-pseudoephdm... 107, 108 budesonide... 164 bufferin... 11 bumetanide... 93 BUPHENYL... 140 buprenorphine hcl... 3, 14 buprenorphine-naloxone... 14 buproban... 42 bupropion hcl... 14, 42, 43 buspirone... 167 butalbital compound w/codeine 3 butalbital-acetaminop-caf-cod. 4 butalbital-acetaminophen... 4 butalbital-acetaminophen-caff. 4 butalbital-aspirin-caffeine... 4 BUTRANS... 4 BYSTOLIC... 87 C c complex... 191 cabergoline... 64 CABOMETYX... 29 ca-d3-mag ox-zinc-cop-mangbor... 176 caffeine citrated... 97 caffeine-sodium benzoate... 97 calci-chew... 140 calcidol... 191 calcipotriene... 119 calcitonin (salmon)... 165 calcitrate... 173 calcitrate-vitamin d... 173 calcitrene... 119 calcitriol... 119, 165 calcium 500 + d... 173 calcium 500 + d (d3)... 175 calcium 600... 173 calcium 600 + d(3)... 173, 174 calcium 600 with vitamin d3 177 calcium acetate... 148 calcium antacid... 140 calcium carbonate... 140, 174 calcium carbonate-vitamin d2... 174 calcium carbonate-vitamin d3... 173, 174, 175, 176, 181 CALCIUM CARBONATE- VITAMIN D3... 140 calcium chloride... 174 calcium citrate-vitamin d3.. 174, 176 calcium gluconate... 174 calcium+d... 182 CALDOLOR... 11 cal-gest antacid... 140 calphron... 148 CALTRATE 600 + D... 174 CALTRATE WITH VITAMIN D3... 174 camila... 100 camrese... 100 camrese lo... 100 CANCIDAS... 50 candesartan... 84 candesartan-hydrochlorothiazid... 84 capacet... 4 CAPASTAT... 60 CAPRELSA... 29 captopril... 85 captopril-hydrochlorothiazide 85 CARAFATE... 137 CARBAGLU... 140 carbamazepine... 38 carbidopa... 64 carbidopa-levodopa... 64 carbidopa-levodopa-entacapone... 64 CARIMUNE NF NANOFILTERED... 156 carisoprodol... 186 carteolol... 130 cartia xt... 88 carvedilol... 87 CASTELLANI PAINT MODIFIED... 119 CAYSTON... 23 caziant (28)... 100 cefaclor... 19, 20 cefadroxil... 20 cefazolin... 20 cefazolin in dextrose (iso-os). 20 CEFAZOLIN IN DEXTROSE (ISO-OS)... 20 cefdinir... 20 cefditoren pivoxil... 20 cefepime... 20 CEFEPIME IN DEXTROSE 5 %... 20 CEFEPIME IN DEXTROSE,ISO-OSM... 20 cefotaxime... 20 cefoxitin... 20 cefoxitin in dextrose, iso-osm 20 cefpodoxime... 21 cefprozil... 21 ceftazidime... 21 ceftibuten... 21 ceftriaxone... 21 ceftriaxone in dextrose,iso-os. 21 cefuroxime axetil... 21 cefuroxime sodium... 21 celecoxib... 11 CELLCEPT INTRAVENOUS... 156 CELONTIN... 38 centamin... 191 centergy dm... 108 central vite with lutein... 202 central-vite... 203 central-vite for seniors... 191 central-vite select... 195, 202 central-vite senior... 202 centram-care... 191 I-4 www.centersplan.com/fida/participants

centravites 50 plus... 191 centrum... 191 centrum complete... 191 centrum silver... 191 century... 197 century adults 50+... 192 century mature... 192, 195, 197 century ultimate women's... 192 cephalexin... 21 CEPROTIN (BLUE BAR)... 74 CERDELGA... 167 CEREZYME... 127 cerovite... 192 cerovite advanced formula... 192 certavite senior-antioxidant.. 192 certavite-antioxid (iron gluc) 192 certavite-antioxidant... 192 CERVARIX VACCINE (PF)... 160 cetirizine... 54 cetirizine-pseudoephedrine... 54 cevimeline... 117 CHANTIX... 14 CHANTIX CONTINUING MONTH BOX... 14 CHANTIX STARTING MONTH BOX... 14 cheracol d... 108 cheratussin dac... 108 chest congestion relief + dm 109 chest congestion relief pe... 109 chewable multi vitamin... 195 child allergy relf(cetirizine)... 55 child complete multivitamin 195 child cough and sore throat.. 110 child mucinex chest congestion... 109 child plus cough and runnynose... 113 child triaminic cold-allergy... 54 child triaminic cough-congest... 108 child vitamin with minerals.. 193 child wal-tap cold-allergy... 55 child wal-tussin cough relief 108 CHILDREN'S ADVIL... 11 children's allegra allergy.. 54, 55 children's aller-tec... 55 children's chest congestion... 110 children's chewable... 202 children's chewable complete... 193 children's chewable vitamin. 192 children's chewable w/minerals... 195 CHILDREN'S CLARITIN54, 55 children's cold-cough daytime... 109 children's complete vitamin. 202 children's mapap... 4 children's mucinex cough... 108 children's multivit w/extra c. 195 children's non-aspirin... 4 children's pain reliever... 9 children's pain-fever relief... 4 children's pepto... 140 childrens plus multi-symp cold... 115 children's silapap... 4 children's silfedrine... 109 children's soothe... 140 children's sudafed... 109 children's sudafed pe cough. 108 children's tactinal... 4 children's wal-dryl allergy... 55 children's wal-zyr... 55 CHILDREN'S ZYRTEC ALLERGY... 55 childs chew vite... 192 child's vitamin with iron... 193 child's vitamin with vitamin c... 193 childs/iron... 192 chlophedianol-guaifenesin... 107 chloramphenicol sod succinate... 17 chlordiazepoxide hcl... 16 chlorhexidine gluconate... 117 chloroquine phosphate... 63 chlorothiazide... 93 chlorothiazide sodium... 93 chlorpheniramine-phenyleph-dm... 107 chlorpromazine... 65 chlorthalidone... 93 chlorzoxazone... 186 cholecalciferol (vitamin d3) 194, 208, 209 cholestyramine (with sugar)... 94 cholestyramine light... 94 choline,magnesium salicylate 11 ciclopirox... 50 ciclopirox-ure-camph-menth-euc... 50 cilostazol... 78 cimetidine... 137 cimetidine hcl... 137 CIMZIA... 156 CIMZIA POWDER FOR RECONST... 156 CINQAIR... 185 CINRYZE... 76 CIPRODEX... 133 ciprofloxacin... 26 ciprofloxacin hcl... 26, 133 ciprofloxacin in 5 % dextrose 26 ciprofloxacin lactate... 26 citalopram... 43 citracal + d maximum... 174 citrus calcium... 174 clarithromycin... 22 CLARITIN... 55 CLARITIN LIQUI-GEL... 55 CLARITIN REDITABS... 55 clearlax... 148 clemastine... 55 I-5 www.centersplan.com/fida/participants

CLEVIPREX... 92 clindamycin hcl... 17 clindamycin in 5 % dextrose.. 18 clindamycin palmitate hcl... 17 clindamycin pediatric... 18 clindamycin phosphate... 18, 59, 121 CLINIMIX 5%/D15W SULFITE FREE... 79 CLINIMIX 5%/D25W SULFITE-FREE... 80 CLINIMIX 2.75%/D5W SULFIT FREE... 80 CLINIMIX 4.25%/D10W SULF FREE... 80 CLINIMIX 4.25%/D5W SULFIT FREE... 80 CLINIMIX 4.25%-D20W SULF-FREE... 80 CLINIMIX 4.25%-D25W SULF-FREE... 80 CLINIMIX 5%- D20W(SULFITE-FREE)... 80 CLINIMIX E 2.75%/D10W SUL FREE... 80 CLINIMIX E 2.75%/D5W SULF FREE... 80 CLINIMIX E 4.25%/D10W SUL FREE... 80 CLINIMIX E 4.25%/D25W SUL FREE... 81 CLINIMIX E 4.25%/D5W SULF FREE... 81 CLINIMIX E 5%/D15W SULFIT FREE... 81 CLINIMIX E 5%/D20W SULFIT FREE... 81 CLINIMIX E 5%/D25W SULFIT FREE... 81 CLINISOL SF 15 %... 81 clobetasol... 123 clobetasol-emollient... 123 clocortolone pivalate... 123 clomipramine... 43 clonazepam... 16 clonidine... 83 clonidine hcl... 83, 97 clopidogrel... 78 clorazepate dipotassium... 16 clorpres... 83 clotrimazole... 50 clotrimazole-7... 50 clotrimazole-betamethasone... 50 clozapine... 65, 66 COARTEM... 63 codeine sulfate... 4 codituss dm... 109 COLACE... 145 colchicine... 167 colchicine-probenecid... 167 cold and cough (diphenhydr-pe)... 56 cold multi-symptom day/night... 109 cold relief m/s day/night... 109 cold-allergy-sinus... 55 cold-flu relief... 109 cold-flu relief, day/night... 109 colestipol... 94 colistin (colistimethate na)... 18 colocort... 123 COLY-MYCIN S... 133 COMBIGAN... 172 COMBIPATCH... 151 COMBIVENT RESPIMAT. 184 COMETRIQ... 29 comfort gel... 140 comfort gel extra strength... 140 COMPLERA... 69 complete 50+... 197 complete multi 50+... 192 complete multivitamin. 192, 195 complete multivitamin-mineral... 195, 204 complete senior... 192, 204 compoz... 55 compro... 61 COMVAX (PF)... 160 CONDYLOX... 119 congestac... 109 congest-eze... 109 constulose... 140 COPAXONE... 168 coricidin hbp... 109 coricidin hbp cold-multi sympt... 109 CORLANOR... 89, 90 cormax... 123 cortisone... 152 cortizone-10... 123 CORTIZONE-10... 123 COSENTYX... 119 COSENTYX (2 SYRINGES)... 119 COSENTYX PEN... 119 COSENTYX PEN (2 PENS) 119 COTELLIC... 29 cough and cold... 109 cough and runny nose... 115 cough relief... 110 CREON... 127 CRESTOR... 94 critic-aid clear af... 50 CRIXIVAN... 69 cromolyn... 130, 140, 185 cryselle (28)... 100 CUBICIN... 18 cyanocobalamin (vitamin b-12)... 190, 194, 203, 208 cyclafem 1/35 (28)... 100 cyclafem 7/7/7 (28)... 100 cyclobenzaprine... 186 cyclopentolate... 130 cyclophosphamide... 29 CYCLOPHOSPHAMIDE... 29 CYCLOSET... 46 I-6 www.centersplan.com/fida/participants

cyclosporine... 156 cyclosporine modified... 156 cyproheptadine... 56 CYRAMZA... 30 cyred... 100 CYSTADANE... 168 CYSTARAN... 130 cysteine (l-cysteine)... 81 D d10 %-0.45 % sodium chloride... 175 d2.5 %-0.45 % sodium chloride... 175 d3 dots... 194 d5 % and 0.9 % sodium chloride... 175 d5 %-0.45 % sodium chloride... 175 dactinomycin... 30 daily gummies... 193 daily multiple... 193, 194 daily multi-vitamin... 199 daily multivitamin with iron 194 daily multi-vitamins/iron... 194 daily teen multi-vitamin... 193 daily value... 194 daily vitamin... 194 daily vitamin formula... 194 daily vitamin formula + iron 194 daily vitamin formula-minerals... 194 daily vitamin with iron... 194 daily vites/iron... 194 dailyhist-1... 56 daily-vite... 194 DAKLINZA... 72, 73 DALIRESP... 185 danazol... 150 dantrolene... 186 dapsone... 60 DAPTACEL (DTAP PEDIATRIC) (PF)... 160 DARAPRIM... 63 DARZALEX... 30 dasetta 1/35 (28)... 100 dasetta 7/7/7 (28)... 100 dayhist allergy... 56 daysee... 101 daytime cold and cough... 110 daytime cold-flu... 110 day-time cough... 110 daytime-nighttime... 113 daytime-nighttime cold-flu.. 110 daytime-nighttime cough... 110 deblitane... 101 decitabine... 30 decongestant cough... 115 deep sea nasal... 130 deferoxamine... 149 delsym cough-chest congest dm... 110 delyla (28)... 101 DELZICOL... 164 DEMSER... 90 DEPEN TITRATABS... 149 DEPO-PROVERA... 155 dermafungal... 51 dermarest eczema (hydrocort)... 123 DESCOVY... 69 desipramine... 43 desmopressin... 153 desog-e.estradiol/e.estradiol. 101 desogestrel-ethinyl estradiol 101 desonide... 123 desoximetasone... 123 despec-dm (pseudoeph-dmguaif)... 110 dex4 glucose... 81 dexamethasone... 152 dexamethasone sodium phosphate... 135, 152 dexmethylphenidate... 97 dextroamphetamine... 97 dextroamphetamineamphetamine... 97, 98 dextromethorphan polistirex 110 dextrose 10 % and 0.2 % nacl... 175 dextrose 10 % in water (d10w)... 81 dextrose 20 % in water (d20w)... 81 dextrose 25 % in water (d25w)... 81 dextrose 40 % in water (d40w)... 81 dextrose 5 % in ringers... 81 dextrose 5 % in water (d5w).. 81 dextrose 5 %-lactated ringers175 dextrose 5%-0.2 % sod chloride... 175 dextrose 5%-0.3 % sod.chloride... 175 dextrose 50 % in water (d50w)... 82 dextrose 70 % in water (d70w)... 82 dextrose with sodium chloride... 175 diabetic tussin dm... 110 diamode... 141 diazepam... 16 diazepam intensol... 16 diclofenac potassium... 11 diclofenac sodium... 11, 135 diclofenac-misoprostol... 11 dicloxacillin... 25 dicyclomine... 141 didanosine... 69 DIFICID... 22 diflunisal... 11 digestive relief... 141 digitek... 90 digox... 90 digoxin... 90 I-7 www.centersplan.com/fida/participants

DIGOXIN... 90 dihydroergotamine... 59 DILANTIN... 38 diltiazem hcl... 88, 89 dilt-xr... 89 dimaphen (pe)... 56 dimenhydrinate... 61 dimetapp cold-congestion... 56 dino-life... 195 dino-life with extra c... 194 dino-life with iron-zinc... 195 DIPENTUM... 164 diphenhist... 56 diphenhydramine hcl... 56 diphenoxylate-atropine... 141 dipyridamole... 78 disopyramide phosphate... 86 disulfiram... 15 divalproex... 38 dobutamine... 90 dobutamine in d5w... 90 doc-q-lace... 145 docu... 145 docusate sodium... 145 docusol... 145 dok... 145 donepezil... 41, 42 dopamine... 90 dopamine in 5 % dextrose... 90 dorzolamide... 172 dorzolamide-timolol... 172 douche vinegar and water extra... 170 doxazosin... 83 doxepin... 43 doxercalciferol... 165 doxorubicin, peg-liposomal... 30 doxy-100... 27 doxycycline hyclate... 27 doxycycline monohydrate... 27 dramamine... 61 dramamine less drowsy... 61 driminate... 61 dristan long lasting... 130 dronabinol... 61 droperidol... 168 drospirenone-ethinyl estradiol... 101 DROXIA... 30 DUAVEE... 151 dulcolax stool softener (dss) 145 DULERA... 182 duloxetine... 43 DUREZOL... 136 dutasteride... 168 dutasteride-tamsulosin... 168 DYRENIUM... 93 E e.c. prin... 11 e.e.s. 400... 22 e.e.s. granules... 22 econazole... 51 econtra ez... 101 ed a-hist... 56 ed bron gp... 110 ed chlorped jr... 56 EDURANT... 69 effer-k... 175 EFFIENT... 78 ELAPRASE... 127 eldertonic... 195 electrolyte-48 in d5w... 175 ELIDEL... 123 ELIGARD... 30 elinest... 101 eliphos... 148 ELIQUIS... 74 ELITEK... 128 ELLA... 101 ellis tonic... 195 ELMIRON... 168 elon dual defense... 51 EMCYT... 30 EMEND... 61 emoquette... 101 EMPLICITI... 30 EMSAM... 43 EMTRIVA... 69 EMVERM... 63 enalapril maleate... 85 enalaprilat... 85 enalapril-hydrochlorothiazide 85 ENBREL... 156, 157 ENBREL SURECLICK... 157 endocet... 4 endodan... 5 endur-acin... 94 enema... 145, 147 enema disposable... 145 enemeez... 145 enemeez plus... 145 ENGERIX-B (PF)... 160 ENGERIX-B PEDIATRIC (PF)... 160 enoxaparin... 74, 75 enpresse... 101 enskyce... 101 entacapone... 64 entecavir... 74 entre-cough... 110 ENTRESTO... 84 enulose... 141 ENVARSUS XR... 157 ephedrine sulfate... 90 epinastine... 130 epinephrine... 91 epinephrine hcl (pf)... 91 EPIPEN 2-PAK... 91 EPIPEN JR 2-PAK... 91 epitol... 38 EPIVIR HBV... 69 eplerenone... 96 EPOGEN... 76 epoprostenol (glycine)... 188 EPZICOM... 69 eq gentle... 130 I-8 www.centersplan.com/fida/participants

equalactin... 146 ergocalciferol (vitamin d2). 195, 207 ergoloid... 168 ERGOMAR... 59 ERIVEDGE... 30 errin... 101 ery pads... 121 ery-tab... 22 ERY-TAB... 22 ERYTHROCIN... 23 erythrocin (as stearate)... 23 erythromycin... 23, 133 erythromycin ethylsuccinate.. 23 erythromycin with ethanol... 121 ESBRIET... 186 escitalopram oxalate... 43 esmolol... 87 esomeprazole sodium... 137 essentia... 195 essential balance with lutein 195 essential daily... 196 estarylla... 101 ESTRACE... 151 estradiol... 151 estradiol valerate... 151 estradiol-norethindrone acet. 151 estropipate... 151 eszopiclone... 187 ethambutol... 60 ethamolin... 91 ethosuximide... 38 etodolac... 11, 12 ETOPOPHOS... 30 etoposide... 30 EVOTAZ... 69 exemestane... 30 EXJADE... 149 expectorant... 111 expectorant dm... 111 expectorant max strength... 111 EXTAVIA... 168 extra cleansing douche... 170 F FABRAZYME... 128 falmina (28)... 101 famciclovir... 74 famotidine... 138 famotidine (pf)... 137 famotidine (pf)-nacl (iso-os) 138 FANAPT... 66 FARESTON... 30 FARYDAK... 30 FASLODEX... 30 felbamate... 38, 39 felodipine... 92 feminine care douche... 170 FEMRING... 151 fenofibrate... 94 fenofibrate micronized... 94 fenofibrate nanocrystallized... 94 fenofibric acid... 94 fenofibric acid (choline)... 94 fenoprofen... 12 fentanyl... 5 fentanyl citrate... 5 ferocon... 196 ferretts... 196 ferrex 150... 196 ferrex 150 plus... 196 FERRIPROX... 149 ferrocite... 196 ferrous fumarate... 196 ferrous gluconate... 196, 198 ferrous sulfate... 192, 196 FETZIMA... 43 feverall... 5 fexofenadine... 56, 57 fiber (calcium polycarbophil)... 146 fiber laxative (methylcellulo)148 fiber smooth... 148 fiber therapy (m-cell/sugar). 146 fiber therapy (m-cellulose)... 145 fiber therapy (psyllium/sugar)... 145 fiber-lax... 146 fibertab... 146 finasteride... 168 FIRAZYR... 91 flanax antacid... 141 FLEBOGAMMA DIF... 157 flecainide... 86 FLECTOR... 12 FLEET BISACODYL... 146 flintstones complete (iron)... 196 flintstones multivitamin... 196 flintstones with iron... 197 flintstones/extra c... 196 FLOVENT DISKUS... 183 FLOVENT HFA... 183 floxuridine... 31 flu formula daytime-nighttime... 113 flu relief therapy daytime... 113 flu severe cold-congestion... 115 flucaine... 130 fluconazole... 51 fluconazole in dextrose(iso-o) 51 fluconazole in nacl (iso-osm). 51 flucytosine... 51 fludrocortisone... 152 flumazenil... 98 flunisolide... 136 fluocinonide... 124 fluocinonide-e... 124 fluorometholone... 136 fluorouracil... 31, 119 fluoxetine... 43, 44 fluphenazine decanoate... 66 fluphenazine hcl... 66 flurbiprofen... 12 flurbiprofen sodium... 136 flutamide... 31 fluticasone... 124, 136 fluvoxamine... 44 I-9 www.centersplan.com/fida/participants

foaming antacid... 141, 144 folic acid... 197 FOLIC ACID... 197 fomepizole... 168 fondaparinux... 75 foot odor control... 53 FORTEO... 166 FORTICAL... 166 foscarnet... 72 fosfree... 197 fosinopril... 85 fosinopril-hydrochlorothiazide... 85 fosphenytoin... 39 FREAMINE HBC 6.9 %... 82 FREAMINE III 10 %... 82 fungi cure... 51 FUNGI-NAIL... 51 fungoid-d... 51 furosemide... 93 FUSILEV... 168 FUZEON... 69 FYCOMPA... 39 G gabapentin... 39 GABITRIL... 39 galantamine... 42 GAMASTAN S/D... 157 GAMMAGARD LIQUID... 157 GAMMAPLEX... 157 ganciclovir sodium... 74 GARDASIL (PF)... 160 GARDASIL 9 (PF)... 160 gas relief... 136, 137 gas relief extra strength... 136 gas-x ultra-strength... 137 gatifloxacin... 133 GATTEX 30-VIAL... 141 GATTEX ONE-VIAL... 141 GAUZE PAD... 168 gavilyte-c... 146 gavilyte-g... 146 gavilyte-n... 146 GAZYVA... 31 gelusil antacid and anti-gas.. 141 gemfibrozil... 94 generlac... 141 gengraf... 157 GENOTROPIN... 153 GENOTROPIN MINIQUICK... 153 gentak... 133 gentamicin... 17, 121, 134 gentamicin in nacl (iso-osm).. 17 gentamicin sulfate (ped) (pf).. 17 gentamicin sulfate (pf)... 17 GENTEAL MILD TO MODERATE... 131 GENTEAL GEL... 130 GENTEAL MILD... 131 GENTEAL SEVERE... 131 genteal tears... 131 gentlelax... 146 GENVOYA... 69 GEODON... 66 geravim... 197 geriaton... 197 geri-hydrolac... 119 geri-tussin dm... 111 gianvi (28)... 101 gildagia... 101 gildess 1.5/30 (21)... 101 gildess 1/20 (21)... 101 gildess 24 fe... 101 gildess fe 1.5/30 (28)... 101 gildess fe 1/20 (28)... 101 GILENYA... 168 GILOTRIF... 31 GLEEVEC... 31 GLEOSTINE... 31 glimepiride... 48 glipizide... 48, 49 glipizide-metformin... 49 GLUCAGEN HYPOKIT... 168 GLUCAGON EMERGENCY KIT (HUMAN)... 168 gluco burst... 82 glucose... 82 glucose gel... 82 glutose 15... 82 glyburide... 49 glyburide micronized... 49 glyburide-metformin... 49 glycolax... 146 glycopyrrolate... 141 glydo... 13 GLYXAMBI... 46 granisetron (pf)... 61 granisetron hcl... 61 GRANIX... 76 griseofulvin microsize... 51 guaifenesin... 111 guaifenesin dac... 111 guanfacine... 83, 98 guanidine... 168 gummi bear multivitamin... 197, 201 gummy swirls... 193 H hair vitamins... 197 hair,skin and nails... 193, 206 halobetasol propionate... 124 haloperidol... 66 haloperidol decanoate... 66 haloperidol lactate... 66 HARVONI... 73 HAVRIX (PF)... 161 head congestion day-night... 111 healthy eyes... 197 healthylax... 146 heather... 101 hemocyte... 197 heparin (porcine)... 75 heparin (porcine) in 5 % dex.. 75 heparin (porcine) in nacl (pf). 75 I-10 www.centersplan.com/fida/participants

heparin(porcine) in 0.45% nacl... 75 heparin, porcine (pf)... 75 HEPATAMINE 8%... 82 HEPATASOL 8 %... 82 HERCEPTIN... 31 HETLIOZ... 187 HEXALEN... 31 hi-b complex... 197 hi-cal plus vit d... 181 homatropaire... 131 homatropine hbr... 131 honey bears... 197 honey bears with iron-zinc... 198 HUMIRA... 157 HUMIRA PEN... 157 HUMIRA PEN CROHN'S-UC- HS START... 157 HUMULIN R U-500 (CONC) KWIKPEN... 47 HUMULIN R U-500 (CONCENTRATED)... 48 hydralazine... 91 hydrochlorothiazide... 93 hydrocil instant... 146 hydrocodone-acetaminophen... 5 hydrocodone-chlorpheniramine... 111 hydrocodone-homatropine... 111 hydrocodone-ibuprofen... 5 hydrocortisone... 124, 125, 152 hydrocortisone acet-aloe vera... 124 hydrocortisone acetate... 124 hydrocortisone acetate-aloe. 124 hydrocortisone butyrate... 124 hydrocortisone butyr-emollient... 124 hydrocortisone valerate... 125 hydromet... 111 hydromorphone... 5, 6 hydromorphone (pf)... 5 hydroskin... 124 hydroxychloroquine... 63 hydroxyurea... 31 hydroxyzine hcl... 168 hydroxyzine pamoate... 168 HYPERLYTE CR... 176 HYPERRAB S/D (PF)... 157 HYQVIA... 158 HYSINGLA ER... 6 I ibandronate... 166 IBRANCE... 31 ibuprofen... 11, 12, 13 ibuprofen jr strength... 12 icaps plus... 198 ICLUSIG... 31 iferex 150... 198 ifosfamide... 31 ifosfamide-mesna... 31 ILARIS (PF)... 158 ILEVRO... 136 IMBRUVICA... 31 imipenem-cilastatin... 23 imipramine hcl... 44 imipramine pamoate... 44 imiquimod... 120 IMLYGIC... 32 imodium a-d... 142 IMODIUM A-D... 142 IMOGAM RABIES-HT (PF)... 158 IMOVAX RABIES VACCINE (PF)... 161 INCRELEX... 153 indapamide... 93 indomethacin... 12 indomethacin sodium... 12 INFANRIX (DTAP) (PF)... 161 infant's ibuprofen... 12 INFANT'S MOTRIN... 12 infants' non-aspirin cold... 117 INLYTA... 32 insta-glucose... 82 INSULIN SYRINGE-NEEDLE U-100... 127 INTELENCE... 69 INTRALIPID... 82 INTRON A... 73 introvale... 102 INVANZ... 23 INVEGA SUSTENNA... 66 INVEGA TRINZA... 67 INVIRASE... 70 INVOKAMET... 46 INVOKANA... 46 inzo antifungal... 51 iodine... 127 IONOSOL-B IN D5W... 176 IONOSOL-MB IN D5W... 176 IPOL... 161 ipratropium bromide... 131, 184 ipratropium-albuterol... 184 IPRIVASK... 75 irbesartan... 84 irbesartan-hydrochlorothiazide... 84 IRESSA... 32 iron high potency... 193 ISENTRESS... 70 ISOLYTE M IN 5 % DEXTROSE... 176 ISOLYTE-H IN 5 % DEXTROSE... 176 ISOLYTE-P IN 5 % DEXTROSE... 176 ISOLYTE-S... 176 isoniazid... 60 isopto tears... 131 isosorbide dinitrate... 96 isosorbide mononitrate... 96 isradipine... 92 itraconazole... 51 ivermectin... 63 IXEMPRA... 32 I-11 www.centersplan.com/fida/participants

IXIARO (PF)... 161 J JAKAFI... 32 jantoven... 76 JANUMET... 46 JANUMET XR... 46 JANUVIA... 46 JARDIANCE... 46 jencycla... 102 JENTADUETO... 46 jolessa... 102 jolivette... 102 jr. acetaminophen... 9 juleber... 102 junel 1.5/30 (21)... 102 junel 1/20 (21)... 102 junel fe 1.5/30 (28)... 102 junel fe 1/20 (28)... 102 junel fe 24... 102 junior mapap... 6 JUXTAPID... 94 K KABIVEN... 82 KALETRA... 70 KALYDECO... 186 KANUMA... 128 kaopectate (bismuth subsalicy)... 142 kariva (28)... 102 k-effervescent... 176 kelnor 1/35 (28)... 102 KELP (IODINE)... 176 ketoconazole... 51 ketoprofen... 12 ketorolac... 12, 136 KEVEYIS... 169 KEYTRUDA... 32 kids mini enema... 145 kid's vitamins... 201 kid's vitamins + extra c... 201 kids vitamins + iron... 201 kid's vitamins + iron... 201 kimidess (28)... 102 KINERET... 158 KINRIX (PF)... 161 kionex... 142 klor-con 10... 176 klor-con m10... 177 klor-con m15... 177 klor-con m20... 177 klor-con sprinkle... 177 konsyl (sugar)... 146 konsyl fiber... 146 KONSYL SUGAR-FREE... 146 KORLYM... 46 KRYSTEXXA... 128 kurvelo... 102 KUVAN... 128 KYNAMRO... 94 KYPROLIS... 32 L l norgest/e.estradiol-e.estrad 102 labetalol... 87 LACRISERT... 131 LACTATED RINGERS... 165 LACTINOL HX... 120 lactulose... 142 LAMICTAL... 39 LAMISIL (AEROSOL)... 52 lamisil af... 51 LAMISIL AT... 52 lamivudine... 70 lamivudine-zidovudine... 70 lamotrigine... 39 LANOXIN... 91 lansoprazole... 138 LANTUS... 48 LANTUS SOLOSTAR... 48 larin 1.5/30 (21)... 102 larin 1/20 (21)... 102 larin 24 fe... 102 larin fe 1.5/30 (28)... 102 larin fe 1/20 (28)... 102 latanoprost... 172 LATUDA... 67 laxative peg 3350... 147 LAZANDA... 6 leena 28... 103 leflunomide... 158 LEMTRADA... 169 LENVIMA... 32 lessina... 103 LETAIRIS... 188 letrozole... 32 leucovorin calcium... 169 LEUKERAN... 32 LEUKINE... 76 leuprolide... 32 levetiracetam... 39 levobunolol... 172 levocarnitine... 169 levocarnitine (with sugar)... 169 levocetirizine... 57 levofloxacin... 26, 134 levofloxacin in d5w... 26 levonest (28)... 103 levonorgestrel... 103 levonorgestrel-ethinyl estrad 103 levonorg-eth estrad triphasic 103 levora-28... 103 levothyroxine... 155 LEXIVA... 70 lice cream rinse... 126 lice killing... 126 lice treatment... 126 lice treatment (permethrin)... 126 lidocaine... 14 lidocaine (pf)... 13, 86 lidocaine hcl... 14 lidocaine in 5 % dextrose (pf) 86 lidocaine viscous... 13 lidocaine-prilocaine... 14 life-pack women's... 198 linezolid... 18 LINZESS... 142 liothyronine... 155 I-12 www.centersplan.com/fida/participants

lipodox... 32 LIPOSYN II... 82 LIPOSYN III... 82 liquibid d-r... 111 liquid calcium with vitamin d... 177 LIQUI-E... 198 lisinopril... 85 lisinopril-hydrochlorothiazide 85 lithium carbonate... 98 lithium citrate... 98 little animals... 198 little animals-iron... 198 lobana bath... 120 lohist-dm... 111 lomedia 24 fe... 103 lomustine... 33 LONSURF... 33 loperamide... 141, 142, 143 loratadine... 57 loratadine-d... 57 lorazepam... 16 lorcet (hydrocodone)... 6 lorcet hd... 6 lorcet plus... 6 lortuss ex... 111 loryna (28)... 103 losartan... 84 losartan-hydrochlorothiazide. 84 LOTEMAX... 136 LOTRONEX... 142 lovastatin... 94 low-ogestrel (28)... 103 loxapine succinate... 67 lubricant dry eye relief... 130 lubricant eye... 130 lubricant eye (cmc-glycer)(pf)... 131 lubricant eye (cmc-glycerin) 131 lubricant eye (pg-peg 400)... 132 lubricant eye (polyv alcohol) 132 lubricant eye (propyl glycol) 131 lubricant eye drops... 130 lubricant gel... 130 lubricating drops... 130 lubrifresh pm... 131 LUMIGAN... 172 LUPRON DEPOT... 33 LUPRON DEPOT (3 MONTH)... 33 LUPRON DEPOT (4 MONTH)... 33 LUPRON DEPOT (6 MONTH)... 33 LUPRON DEPOT-PED... 154 LUPRON DEPOT-PED (3 MONTH)... 154 lutera (28)... 103 LYNPARZA... 33 LYRICA... 40 lysiplex plus... 198 LYSODREN... 33 lyza... 103 M maalox advanced... 142 MACUVITE... 198 MACUVITE EYE CARE... 198 mag 64... 177 mag-delay... 177 mag-g... 177 MAGNEBIND 300... 142 magnebind 400... 148 magnesium... 175, 177 magnesium (oxide/aa chelate)... 177 magnesium chloride... 177 magnesium gluconate... 177 magnesium oxide... 142, 143 magnesium sulf in 0.45% nacl... 177 magnesium sulfate... 178 magnesium sulfate in d5w... 177 magnesium sulfate in water.. 178 malathion... 126 mapap (acetaminophen)... 6 mapap arthritis pain... 6 mapap extra strength... 6 maprotiline... 44 mar-cof bp... 111 mar-cof cg... 111 margesic... 6 marlissa... 103 MARPLAN... 44 masanti double strength... 142 MATULANE... 33 matzim la... 89 maximum daily multivitamin... 202 maximum strength flu... 113 meclizine... 61, 62 medroxyprogesterone... 155 mefenamic acid... 12 mefloquine... 63 MEFOXIN IN DEXTROSE (ISO-OSM)... 22 mega multiple/chelated mineral... 198 mega multivitamin with mineral... 198 MEGACE ES... 155 megestrol... 33, 155 MEKINIST... 33 meloxicam... 13 memantine... 42 MENACTRA (PF)... 161 MENEST... 151 MENHIBRIX (PF)... 161 MENOMUNE - A/C/Y/W-135 (PF)... 161 men's daily gummies... 193 men's multi-vitamin... 193 men's one daily... 195 MENVEO A-C-Y-W-135-DIP (PF)... 161 MENVEO MENA COMPONENT (PF)... 162 I-13 www.centersplan.com/fida/participants

MENVEO MENCYW-135 COMPNT (PF)... 162 MEPHYTON... 198 mercaptopurine... 33 meropenem... 23 mesehist dm... 111 mesna... 169 MESNEX... 169 MESTINON... 169 MESTINON TIMESPAN... 169 metaproterenol... 184 metaxall... 186 metaxalone... 186 metformin... 46, 47 methadone... 6 methadose... 6 methazolamide... 172 methenamine hippurate... 18 methimazole... 156 methocarbamol... 186 methotrexate sodium... 33, 34 methotrexate sodium (pf)... 33 methoxsalen rapid... 120 methscopolamine... 143 methyclothiazide... 93 methylphenidate... 98, 99 methylprednisolone... 152 methylprednisolone acetate.. 152 methylprednisolone sodium succ... 152, 153 metipranolol... 172 metoclopramide hcl... 143 metolazone... 93 metoprolol succinate... 87 metoprolol ta-hydrochlorothiaz... 88 metoprolol tartrate... 88 metronidazole... 18, 59, 121 metronidazole in nacl (iso-os) 18 mexiletine... 86 mgo... 143 MIACALCIN... 166 mi-acid... 143 mi-acid gas relief... 137 micatin... 52 miconazole 7... 52 miconazole nitrate... 51, 52 miconazole-3... 52 microgestin 1.5/30 (21)... 103 microgestin 1/20 (21)... 103 microgestin fe 1.5/30 (28)... 103 microgestin fe 1/20 (28)... 103 midodrine... 84 miglitol... 47 milk of magnesia... 146 milltrium senior... 198 milrinone... 91 milrinone in 5 % dextrose... 91 mimvey... 151 mimvey lo... 151 mineral oil... 170, 171 MINERAL OIL... 169 mineral oil laxative... 146 minitran... 96 minocycline... 27 minoxidil... 96 mintox... 143 mintox maximum strength... 143 mintox plus... 143 MIRCERA... 76 mirtazapine... 44 misoprostol... 138 mitoxantrone... 34 M-M-R II (PF)... 162 moexipril... 85 moexipril-hydrochlorothiazide... 86 molindone... 67 mometasone... 125 MONISTAT 3... 52 monistat 7... 52 mono-linyah... 104 mononessa (28)... 104 montelukast... 183 morphine... 7 MORPHINE... 7 morphine (pf) in 0.9 % nacl... 6 morphine concentrate... 7 morphine in dextrose 5 %... 7 morrhuate sodium... 169 motion sickness... 61 motion sickness (meclizine)... 62 MOVANTIK... 143 MOVIPREP... 146 MOXEZA... 134 moxifloxacin... 26 MOZOBIL... 76 mucus dm... 111 mucus dm max... 111 mucus relief... 112, 113 mucus relief cough... 115 MULTAQ... 86 multi complete with iron... 198 multi-day with iron... 198 multi-delyn with iron... 199 multiple vitamin-minerals... 199 multiple vitamins... 199 multiple vitamins with iron.. 199 multi-symptom cold night time... 113 multivital platinum... 202 multivitamin 50 plus... 201 multi-vitamin hp/minerals... 199 multivitamin with fluoride... 199 multivitamin with iron.. 199, 204 multivitamin with minerals.. 199 multi-vite... 202 multi-vite 50 and over... 202 mupirocin... 121 mupirocin calcium... 121 muro 128... 131 my favorite multiple... 199 my way... 104 myco nail a... 52 mycophenolate mofetil... 158 mycophenolate sodium... 158 I-14 www.centersplan.com/fida/participants

MYOZYME... 128 MYRBETRIQ... 148 mytab gas... 137 mytab gas maximum strength... 137 my-vitalife... 199 myzilra... 104 N nabumetone... 13 nadolol... 88 nafcillin... 25 NAGLAZYME... 128 naloxone... 15 naltrexone... 15 NAMENDA XR... 42 NAMZARIC... 42 naphazoline... 131 naproxen... 13 naproxen sodium... 13 naratriptan... 59 NARCAN... 15 nasal and sinus decongestant 112 nasal decongestant (oxymetazl)... 131 NASCOBAL... 199 nasohist dm... 112 NATACYN... 134 nateglinide... 47 NATPARA... 166 natural b-100... 209 natural b-100 complex... 204 natural balance... 131 natural calcium... 178 natural fiber laxative therapy 146 natural tears (pf)... 130 nature's tears (hypromellose) 131 NEBUPENT... 63 necon 0.5/35 (28)... 104 necon 1/35 (28)... 104 necon 1/50 (28)... 104 necon 10/11 (28)... 104 necon 7/7/7 (28)... 104 nefazodone... 44 neomycin... 17 neomycin-bacitracin-poly-hc 134 neomycin-bacitracin-polymyxin... 134 neomycin-polymyxin b gu... 121 neomycin-polymyxin b- dexameth... 134 neomycin-polymyxingramicidin... 134 neomycin-polymyxin-hc... 134 neo-polycin... 134 neo-polycin hc... 134 neosporin (neo-bac-polym).. 121 neosporin anti-itch... 125 neo-synephrine 12 h spr (oxym)... 132 neo-tuss... 112 nephplex rx... 199 NEPHRAMINE 5.4 %... 82 nephron fa... 199 nephro-vite rx... 199 NEULASTA... 76, 77 NEUMEGA... 77 NEUPOGEN... 77 NEUPRO... 64 NEVANAC... 136 nevirapine... 70 NEXAFED... 112 NEXAVAR... 34 next choice one dose... 104 niacin... 95 niacinamide... 95, 199 niacor... 95 nicardipine... 92 NICODERM CQ... 15 nicorelief... 15 nicorette... 15 nicotine... 15 nicotine (polacrilex)... 15 NICOTROL... 15 nifedical xl... 92 nifedipine... 92 night time... 113 night time cold-flu... 115 night time cold-flu relief... 115 night time cough-sore throat 112 nighttime cough... 112 nikki (28)... 104 NILANDRON... 34 NINLARO... 34 NITE TIME COLD-FLU RELIEF... 112 nite time-d cold-flu relief... 112 NITRO-BID... 96 nitrofurantoin macrocrystal... 18 nitrofurantoin monohyd/m-cryst... 19 nitroglycerin... 97 nitroglycerin in 5 % dextrose. 96 NITROSTAT... 97 NIX CREME RINSE... 126 nohist-dm... 112 non-aspirin cold... 115 non-aspirin extra strength... 8, 9 non-aspirin flu... 117 non-aspirin jr strength... 4 nora-be... 104 NORDITROPIN FLEXPRO 154 norepinephrine bitartrate... 91 norethindrone (contraceptive)... 104 norethindrone acetate... 155 norethindrone ac-eth estradiol... 104 norethindrone-e.estradiol-iron... 104 norgestimate-ethinyl estradiol... 104 norlyroc... 104 NORMOSOL-M IN 5 % DEXTROSE... 178 NORMOSOL-R PH 7.4... 178 nortemp... 8 I-15 www.centersplan.com/fida/participants

NORTHERA... 84 nortrel 0.5/35 (28)... 104 nortrel 1/35 (21)... 105 nortrel 1/35 (28)... 105 nortrel 7/7/7 (28)... 105 nortriptyline... 44 NORVIR... 70 NOVOLIN 70/30... 48 NOVOLIN N... 48 NOVOLIN R... 48 NOVOLOG... 48 NOVOLOG FLEXPEN... 48 NOVOLOG MIX 70-30... 48 NOVOLOG MIX 70-30 FLEXPEN... 48 NOVOLOG PENFILL... 48 NOXAFIL... 52 NUCALA... 186 NUCYNTA... 8 NUCYNTA ER... 8 NUEDEXTA... 99 nu-iron... 199 NULOJIX... 158 nu-mag... 178 NUPLAZID... 67 NUTRESTORE... 143 NUTRILIPID... 83 NUTRILYTE... 178 NUTRILYTE II... 178 NUVARING... 105 NUVIGIL... 187 nyamyc... 52 nystatin... 52 nystatin-triamcinolone... 53 nystop... 53 nyt-time sleep... 57 O ocean nasal... 132 ocella... 105 OCTAGAM... 158 octreotide acetate... 154 ocutabs... 200 ODEFSEY... 70 ODOMZO... 34 OFEV... 186 ofloxacin... 26, 134, 135 ogestrel (28)... 105 olanzapine... 67 olanzapine-fluoxetine... 44 olopatadine... 132 OLYSIO... 73 omega-3 acid ethyl esters... 95 omeprazole... 138 omeprazole magnesium... 138 omeprazole-sodium bicarbonate... 138 ONCASPAR... 34 oncovite... 200 ondansetron... 62 ondansetron hcl... 62 ondansetron hcl (pf)... 62 one daily... 200, 203 one daily 50 plus... 195 one daily complete... 200 one daily energy... 203 one daily essential 195, 197, 200 one daily maximum (with ca)... 195 one daily multi-vit w-mineral... 200 one daily multivitamin... 200 one daily multivit-iron(folic) 200 one daily plus iron 197, 200, 203 one daily plus minerals... 200 one daily with iron... 200 one-a-day essential... 200 one-a-day maximum formula200 one-a-day teen advantage... 200 ONFI... 16, 125 opcicon one-step... 105 OPDIVO... 34 OPSUMIT... 188 opti-vitamins... 204 oral saline laxative... 147 oralone... 118 ORENCIA... 158 ORENCIA (WITH MALTOSE)... 158 ORENITRAM... 188 ORFADIN... 128 ORKAMBI... 186 orsythia... 105 OTEZLA... 169 OTEZLA STARTER... 169 OTREXUP (PF)... 169 oxacillin... 25 oxacillin in dextrose(iso-osm) 25 oxandrolone... 150 oxcarbazepine... 40 OXTELLAR XR... 40 oxybutynin chloride... 149 oxycodone... 8 oxycodone-acetaminophen... 8 oxycodone-aspirin... 8 OXYCONTIN... 8 oxymorphone... 9 oysco 500/d... 178 oysco d... 178 oysco-500... 178 oyster shell calcium 500... 178 oyster shell calcium with d... 181 oyster shell calcium-vit d3.. 178, 179 oystercal-d... 179 P pacerone... 86 pain relief... 9 pain relief adult... 4 pain reliever jr strength... 9 paliperidone... 67 pancrelipase 5000... 128 PANRETIN... 120 PANTILINERS... 169 pantoprazole... 138 papaverine... 91 paricalcitol... 166 I-16 www.centersplan.com/fida/participants

paromomycin... 63 paroxetine hcl... 44 PASER... 60 PATADAY... 132 PAXIL... 44 pecgen dmx... 112 pedia relief... 115 pedia relief cough-cold... 112 pedia relief infant... 117 pediacare multi-symptom cold... 112 PEDIARIX (PF)... 162 pediatric electrolyte... 175, 179, 181 pediatric freezer pops... 181 pediatric multivitamin.. 199, 203 PEDVAX HIB (PF)... 162 peg 3350-electrolytes... 147 PEGANONE... 40 PEGASYS... 73 PEGASYS PROCLICK... 73 peg-electrolyte soln... 147 PEGINTRON... 73 PEN NEEDLE, DIABETIC. 127 penicillin g pot in dextrose... 25 penicillin g potassium... 25 penicillin g procaine... 25 penicillin v potassium... 25 PENTACEL (PF)... 162 PENTACEL ACTHIB COMPONENT (PF)... 162 PENTAM... 63 pentoxifylline... 78 pep-t-med... 142 peri-colace... 147 PERIKABIVEN... 83 perindopril erbumine... 86 periogard... 118 permethrin... 126 perphenazine... 67 perphenazine-amitriptyline... 45 persa-gel... 120 pfizerpen-g... 25 pharbetol... 9 pharmacist favorite multi-vit 200 phenadoz... 62 phenelzine... 45 phenobarbital... 40 phenobarbital sodium... 40 phenylephrine hcl... 84, 132 phenylhistine dh... 112 phenytoin... 40 phenytoin sodium... 40 phenytoin sodium extended... 40 philith... 105 phillips... 143 phillips liqui-gels... 147 PHOSLYRA... 148 PHOS-NAK... 179 phospha 250 neutral... 179 phosphate laxative... 147 PHOSPHOLINE IODIDE... 173 phytonadione (vitamin k1)... 209 PICATO... 120 pilocarpine hcl... 118, 173 pimozide... 67 pimtrea (28)... 105 pindolol... 88 pink bismuth... 143 pioglitazone... 47 pioglitazone-glimepiride... 47 pioglitazone-metformin... 47 piperacillin-tazobactam... 25, 26 pirmella... 105 piroxicam... 13 PLAN B ONE-STEP... 105 PLASMA-LYTE 148... 179 PLASMA-LYTE A... 179 PLASMA-LYTE-56 IN 5 % DEXTROSE... 179 PLEGRIDY... 170 podocon... 120 podofilox... 120 polyethylene glycol 3350... 147 poly-iron... 200 polymyxin b sulfate... 19 polymyxin b sulf-trimethoprim... 135 poly-tussin... 112 poly-vita... 200 poly-vita (iron)... 201 poly-vitamin... 201 poly-vitamin with iron... 201 poly-vitamins... 201 POMALYST... 34 portia... 105 PORTRAZZA... 34 potassium acetate... 179 potassium bicarb and chloride... 179 potassium bicarb-citric acid. 179 potassium chlorid-d5-0.45%nacl... 179 potassium chloride... 180, 181 potassium chloride in 0.9%nacl... 179 potassium chloride in 5 % dex... 179 potassium chloride in lr-d5... 180 potassium chloride-0.45 % nacl... 180 potassium chloride-d5-0.2%nacl... 180 potassium chloride-d5-0.3%nacl... 180 potassium chloride-d5-0.9%nacl... 180 potassium citrate... 180 potassium citrate-citric acid. 180 potassium hydroxide... 120 potassium phosphate m-/d-basic... 181 POTIGA... 40 PRADAXA... 76 PRALUENT PEN... 95 PRALUENT SYRINGE... 95 I-17 www.centersplan.com/fida/participants

pramipexole... 64 pravastatin... 95 prazosin... 84 prednicarbate... 125 prednisolone acetate... 136 prednisolone sodium phosphate... 136, 153 prednisone... 153 PREMARIN... 151 PREMASOL 10 %... 83 PREMASOL 6 %... 83 PREMPHASE... 152 PREMPRO... 152 prenatal... 197, 201, 204 prenatal formula... 202 prenatal plus (calcium carb). 200 prenatal tablet... 203 prenatal vit#96-ferrous fum-fa... 201 prenatal vitamin... 193, 201 prenatal vitamin plus low iron... 201 prenatal vitamin with minerals... 201 prenatal vit-iron fumarate-fa 201 preparation h hydrocortisone 125 PREVAIL BLADDER CONTROL PAD... 144 prevalite... 95 PREVIDENT 5000 SENSITIVE... 118 previfem... 105 PREZCOBIX... 70 PREZISTA... 71 PRIFTIN... 60 PRILOSEC OTC... 138 PRIMAQUINE... 63 primidone... 40 PRISTIQ... 45 PRIVIGEN... 158 PROAIR HFA... 184 PROAIR RESPICLICK... 184 probenecid... 170 procainamide... 86 PROCALAMINE 3%... 83 prochlorperazine... 62 prochlorperazine edisylate... 62 prochlorperazine maleate... 62 PROCRIT... 77 procto-med hc... 125 procto-pak... 125 proctosol hc... 125 proctozone-hc... 125 PROCYSBI... 170 progesterone in oil... 155 progesterone micronized... 155 PROGLYCEM... 97 PROGRAF... 158 PROLASTIN-C... 186 PROLENSA... 136 PROLEUKIN... 34 PROLIA... 166 PROMACTA... 77 promethazine... 57, 62 promethazine vc-codeine... 112 promethazine-codeine... 112 promethazine-dm... 113 promethegan... 62 promolaxin... 147 propafenone... 86, 87 propantheline... 37 proparacaine... 132 propranolol... 88 propranolol-hydrochlorothiazid... 88 propylthiouracil... 156 PROQUAD (PF)... 162 prosight... 201 PROSOL 20 %... 83 protamine... 77 protriptyline... 45 pseudoephedrine hcl... 113 PULMOZYME... 128 pure and gentle eye... 132 purelax... 145 PURIXAN... 34 pyrazinamide... 60 pyridostigmine bromide... 170 pyridoxine (vitamin b6)... 202 Q q-dryl... 57 q-pap... 9 q-pap extra strength... 9 q-tapp dm... 113 q-tussin... 113 q-tussin dm... 113 QUADRACEL (PF)... 162 quasense... 105 quetiapine... 67 QUILLIVANT XR... 99 quinapril... 86 quinapril-hydrochlorothiazide 86 quinidine gluconate... 87 quinidine sulfate... 87 quinine sulfate... 63 QVAR... 183 R RABAVERT (PF)... 162 raloxifene... 152 ramipril... 86 RANEXA... 92 ranitidine hcl... 138, 139 RAPAMUNE... 159 RASUVO (PF)... 170 RAVICTI... 143 react... 105 REBIF (WITH ALBUMIN). 170 REBIF REBIDOSE... 170 REBIF TITRATION PACK 170 reclipsen (28)... 105 RECOMBIVAX HB (PF)... 163 recort plus... 125 refenesen... 114 refenesen pe... 114 REFRESH CELLUVISC... 132 REFRESH CLASSIC (PF)... 132 I-18 www.centersplan.com/fida/participants

REFRESH LACRI-LUBE... 132 REFRESH OPTIVE... 132 REFRESH OPTIVE ADVANCED... 135 reguloid... 147 relcof c... 114 RELENZA DISKHALER... 72 RELISTOR... 143 remedy phytoplex antifungal. 53 REMICADE... 170 REMODULIN... 188 RENAGEL... 148 rena-vite rx... 203 RENVELA... 148 repaglinide... 47 repaglinide-metformin... 47 REPATHA SURECLICK... 95 REPATHA SYRINGE... 95 reprexain... 9 RESCRIPTOR... 71 RESTASIS... 136 retaine cmc... 132 RETROVIR... 71 revive plus... 130 REVLIMID... 34 revonto... 186 REXULTI... 67 REYATAZ... 71 REZIRA... 114 ribasphere... 74 RIDAURA... 159 rifabutin... 60 rifampin... 60, 61 RIFATER... 61 ri-gel ii... 144 riluzole... 99 rimantadine... 72 ri-mox... 144 ringers... 165, 181 risedronate... 166 RISPERDAL CONSTA... 68 risperidone... 68 RITUXAN... 34 rivastigmine... 42 rivastigmine tartrate... 42 rizatriptan... 59 robafen... 114 robafen cough... 114 robafen dm... 114 robitussin cough-chest cong dm... 114 ROBITUSSIN LONG-ACTING... 114 robitussin pediatric... 114 ropinirole... 64 rosadan... 121 ROTARIX... 163 ROTATEQ VACCINE... 163 roxicet... 9 ROZEREM... 187 rydex... 114 rynex dm... 114 S SABRIL... 40, 41 safe tussin dm... 114 SAIZEN... 154 SAIZEN CLICK.EASY... 154 saline mist... 132 SANDOSTATIN LAR DEPOT... 154 SANTYL... 120 SAPHRIS (BLACK CHERRY)... 68 SAVELLA... 99 scooby-doo one a day... 203 scot-tussin dm... 114 scot-tussin expectorant... 114 sea soft nasal mist... 132 selegiline hcl... 64 selenium sulfide... 121, 122 SELZENTRY... 71 senexon... 147 senior tabs... 203 senna... 147 senna lax... 147 senna laxative... 145 senna with docusate sodium. 145 senokot-s... 148 SENSIPAR... 171 sentry... 203 sentry senior... 203 SEREVENT DISKUS... 184 SEROSTIM... 154 sertraline... 45 setlakin... 105 sharobel... 105 SIGNIFOR... 171 silace... 148 siladryl sa... 57 silapap... 9 sildenafil... 188 SILENOR... 45 siltussin sa... 114 siltussin-dm... 114 silver nitrate... 122 silver sulfadiazine... 122 SIMBRINZA... 173 simethicone... 137 simply sleep... 57 SIMPONI... 171 SIMPONI ARIA... 171 simvastatin... 95 sinus and allergy(pseudoephed)... 57 sirolimus... 159 SIRTURO... 61 skin treatment... 119 sleep aid (diphenhydramine).. 57 sleep aid (doxylamine)... 57 smoothlax... 148 sodium acetate... 181 sodium bicarbonate... 144, 181 sodium chloride... 132, 165, 182, 186 sodium chloride 0.45 %... 181 sodium chloride 0.9 %... 181 I-19 www.centersplan.com/fida/participants

sodium chloride 3 %... 181 sodium chloride 5 %... 181 sodium fluoride... 118, 204 sodium lactate... 182 sodium phosphate... 182 sodium polystyrene (sorb free)... 144 sodium polystyrene sulfonate... 144 sodium thiosulfate... 150 SOLTAMOX... 34 SOLU-CORTEF (PF)... 153 SOMATULINE DEPOT... 155 SOMAVERT... 155 soothe (bismuth subsalicylate)... 144 soothe regular strength... 144 sorbitol... 165 sorbitol-mannitol... 165 sorine... 88 sotalol... 88 sotalol af... 88 SOVALDI... 73 spectravite... 193 spectravite adult 50+... 193 spectravite advanced formula... 193 spectravite senior... 193 spectravite senior w-lycopene... 193 spectravite ultra women... 193 SPIRIVA RESPIMAT... 184 SPIRIVA WITH HANDIHALER... 184 spironolactone... 96 spironolacton-hydrochlorothiaz... 96 sprintec (28)... 105 SPRITAM... 41 SPRYCEL... 34 sps... 144 sronyx... 105 ssd... 122 st joseph aspirin... 13 st. joseph aspirin... 13 stavudine... 71 STELARA... 171 STERILE PADS... 171 STIOLTO RESPIMAT... 37 STIVARGA... 35 stomach relief... 144 stool softener... 145 STRATTERA... 99 STRENSIQ... 128 streptomycin... 17 stress 500 plus zinc... 202 stress b with zinc... 205 stress b-biotin... 205 stress formula... 205 stress formula plus iron... 205 stress formula with iron... 205 stress formula with zinc... 205 STRIBILD... 71 STRIVERDI RESPIMAT... 184 sucralfate... 139 sudafed... 115 sudogest... 115 sudogest sinus and allergy... 57 sulfacetamide sodium... 135 sulfacetamide sodium (acne) 122 sulfacetamide-prednisolone. 135 sulfadiazine... 26 sulfamethoxazole-trimethoprim... 26 sulfasalazine... 26, 27 sulfatrim... 27 sulindac... 13 sumatriptan... 60 sumatriptan succinate... 59, 60 summer's eve disposable douche... 171 summers eve extra cleansing 171 sunvite... 205 super b complex-vitamin c.. 194, 204, 205 super b maxi complex... 205 super b/c... 205 super b-50 complex... 205 super b-50 complex plus... 205 super multiple... 205 super multivitamin... 205 super quints... 205 super quints b-50... 206 super thera vite m... 206 superior 35... 206 superplex-t... 206 suphedrin... 115 suphedrine pe day-night... 116 suphedrine severe cold max str... 115 support... 206 support-500... 206 SUPPRELIN LA... 155 SUPRAX... 22 SURMONTIL... 45 SUSTIVA... 71 SUTENT... 35 syeda... 105 SYLATRON... 74 SYLVANT... 35 SYMLINPEN 120... 47 SYMLINPEN 60... 47 SYNAGIS... 72 SYNAREL... 171 SYNERCID... 19 SYNJARDY... 47 SYNRIBO... 35 SYPRINE... 150 SYSTANE (PROPYLENE GLYCOL)... 132 SYSTANE GEL... 133 T tab-a-vite... 206 tab-a-vite/iron... 206 tab-a-vite-minerals... 206 I-20 www.centersplan.com/fida/participants

TABLOID... 35 tacrolimus... 125, 159 tactinal... 9 tactinal extra strength... 10 TAFINLAR... 35 TAGRISSO... 35 TALTZ AUTOINJECTOR.. 120 TALTZ SYRINGE... 120 TAMIFLU... 72 tamoxifen... 35 tamsulosin... 149 TARCEVA... 35 TARGRETIN... 35 tarina fe 1/20 (28)... 105 TASIGNA... 35 tazicef... 22 TAZORAC... 126 taztia xt... 89 tears again... 133 tears again (pva)... 133 tears naturale free (pf)... 133 TECENTRIQ... 35 TECFIDERA... 171 TECHNIVIE... 73 TEFLARO... 22 telmisartan... 84 telmisartan-hydrochlorothiazid... 84 TEMODAR... 35 tencon... 10 TENIVAC (PF)... 163 terazosin... 149 terbinafine hcl... 53 terbutaline... 184, 185 terconazole... 59 testosterone... 150 testosterone cypionate... 150 testosterone enanthate... 150 TETANUS TOXOID,ADSORBED (PF)... 163 TETANUS,DIPHTHERIA TOX PED(PF)... 163 tetanus-diphtheria toxoids-td 163 tetrabenazine... 99 tetracaine hcl (pf)... 133 tetracycline... 28 THALOMID... 171 the magic bullet... 146 theochron... 185 theophylline... 185 theophylline in dextrose 5 % 185 thera m plus (ferrous fumarat)... 206 thera vitamin... 206 thera-d... 206 theradex m... 206 THERAFLU DAYTIME COLD-COUGH... 116 THERAFLU MULTI- SYMPTOM COLD... 116 thera-m... 206 therapeutic liquid... 198 therapeutic m + beta-carotene... 203 therapeutic-m... 206 therapeutic-m vitamin/minerals... 204 thera-tabs... 206 theratrum complete 50 plus.. 206 theratrum complete 50 plus/lut... 206 thiamine hcl (vitamin b1)... 207 thioridazine... 68 thiotepa... 35 thiothixene... 68 tiagabine... 41 TICE BCG... 159 TIKOSYN... 87 tilia fe... 106 timolol maleate... 88, 173 TIVICAY... 71 tizanidine... 186, 187 TOBI PODHALER... 17 TOBRADEX... 135 TOBRADEX ST... 135 tobramycin... 135 tobramycin in 0.225 % nacl... 17 tobramycin in 0.9 % nacl... 17 tobramycin sulfate... 17 tobramycin-dexamethasone.. 135 TOLAK... 120 tolazamide... 49 tolbutamide... 49 tolmetin... 13 tolnaftate... 53 tolterodine... 149 topiragen... 41 topiramate... 41 toposar... 35 torsemide... 93 total b/c... 207 totalday multiple... 207 TOUJEO SOLOSTAR... 48 TOVIAZ... 149 TPN ELECTROLYTES... 182 TPN ELECTROLYTES II... 182 TRACLEER... 188 TRADJENTA... 47 tramadol... 10 tramadol-acetaminophen... 10 trandolapril... 86 tranexamic acid... 77 TRANSDERM-SCOP... 62 tranylcypromine... 45 TRAVASOL 10 %... 83 TRAVATAN Z... 173 travel sickness (meclizine)... 62 travoprost (benzalkonium)... 173 trazodone... 45 TREANDA... 35, 36 TRECATOR... 61 TRELSTAR... 36 tretinoin... 126 tretinoin (chemotherapy)... 36 I-21 www.centersplan.com/fida/participants

tretinoin microspheres... 126 TREXALL... 36 triacting m-sym cold/cough. 117 triamcinolone acetonide... 118, 125, 153 triaminic cold and cough (pe)... 116 TRIAMINIC COLD AND COUGHNT(PE)... 57 TRIAMINIC COUGH-SORE THROAT... 116 triamterene-hydrochlorothiazid... 93 trianex... 125 TRIBENZOR... 85 tri-buffered aspirin... 13 tri-dex pe... 116 tri-estarylla... 106 trifluoperazine... 68 trifluridine... 135 trihexyphenidyl... 64 tri-legest fe... 106 tri-linyah... 106 tri-lo-estarylla... 106 tri-lo-marzia... 106 tri-lo-sprintec... 106 trilyte with flavor packets... 148 trimethoprim... 19 trimipramine... 45 trinessa (28)... 106 TRINTELLIX... 45 triple antibiotic... 121, 122 triple paste af... 53 tri-previfem (28)... 106 tri-sprintec (28)... 106 TRIUMEQ... 71 tri-vi-sol... 207 tri-vita... 207 tri-vitamin... 207 trivora (28)... 106 TROKENDI XR... 41 TROPHAMINE 10 %... 83 TROPHAMINE 6%... 83 trospium... 149 TRULICITY... 47 TRUMENBA... 163 TRUVADA... 71 trymine cg... 116 TUDORZA PRESSAIR... 185 tusnel diabetic... 116 TUSNEL NEW FORMULA 116 TUSNEL PEDIATRIC... 116 TUSSI PRES-B... 116 tussin cf... 115, 117 tussin cf cough-cold... 116 tussin cold-congestion... 116 tussin cough (dm only)... 110 tussin dm... 114, 116 tussin dm cough and chest... 110 tussin maximum strength... 110 tussin pe... 113 TWINRIX (PF)... 163 TYBOST... 171 TYGACIL... 28 TYKERB... 36 TYPHIM VI... 163 TYSABRI... 159 TYVASO... 188 TYVASO REFILL KIT... 189 TYVASO STARTER KIT... 189 TYZEKA... 74 U u-cort... 125 ULORIC... 171 ultra b-100 complex... 207 ultra fresh pm... 133 ultra strength antacid... 139 unisom sleepgels... 57 UNITUXIN... 36 UPTRAVI... 189 ursodiol... 144 V VAGIFEM... 152 valacyclovir... 74 VALCHLOR... 120 valganciclovir... 74 valproate sodium... 41 valproic acid... 41 valproic acid (as sodium salt). 41 valsartan... 85 valsartan-hydrochlorothiazide 85 VALSTAR... 36 valu-tapp dm... 115 VANACOF... 116 vancomycin... 19 vancomycin in dextrose 5 %.. 19 VAQTA (PF)... 164 VARIVAX (PF)... 164 VASCEPA... 95 v-c forte... 207 VELCADE... 36 velivet triphasic regimen (28)... 106 VENCLEXTA... 36 VENCLEXTA STARTING PACK... 36 venlafaxine... 45 VENTOLIN HFA... 185 verapamil... 89 VERSACLOZ... 68 vestura (28)... 106 VGO 40... 127 VIBERZI... 144 vic-forte... 207 vicks dayquil cold-flu relief. 116 vicks dayquil cough... 116 vicks nature fusion cough... 116 vicks nyquil severe cold-flu. 117 vicks qlearquil(oxymetazoline)... 133 vicks sinex 12-hour... 133 vicodin... 10 vicodin es... 10 vicodin hp... 10 VICTOZA 3-PAK... 47 I-22 www.centersplan.com/fida/participants

VIDEX 2 GRAM PEDIATRIC... 71 VIDEX 4 GRAM PEDIATRIC... 71 VIEKIRA PAK... 73 vienva... 106 VIGAMOX... 135 VIIBRYD... 45 VIMIZIM... 128 VIMPAT... 41 vinorelbine... 36 viorele (28)... 106 VIRACEPT... 72 VIRAMUNE XR... 72 VIRAZOLE... 74 virdec dm... 117 VIREAD... 72 virt-phos 250 neutral... 182 virtussin ac... 117 vision... 207 vision formula... 195 vision formula (with lutein) 194, 207 vision plus lutein... 207 vit b complex-folic acid... 204 vitalets... 207 vitamin a... 207 vitamin b complex... 190, 202 vitamin b-100 complex... 194 vitamin b12-folic acid... 208 vitamin b-6... 208 vitamin c... 203, 208 vitamin d3... 204, 208, 209 vitamins and minerals... 207 vitamins b complex... 190, 208 vitamins for hair... 209 VITEKTA... 72 vitrum senior... 209 VOLTAREN... 13 voriconazole... 53 VOTRIENT... 36 VPRIV... 128 VRAYLAR... 68 vyfemla (28)... 106 W wal-act d cold and allergy... 58 wal-dram... 62 wal-dryl allergy... 58 wal-fex allergy... 58 wal-finate... 58 wal-finate-d... 58 wal-itin... 58 wal-itin d... 58 wal-itin d 12 hour... 58 wal-phed... 58, 117 wal-phed pe day-night... 117 wal-phed pe sinus and allergy 58 wal-profen... 13 wal-sleep z... 58 wal-som (diphenhydramine).. 58 wal-som (doxylamine)... 58 wal-tap... 58 wal-tussin cough... 117 wal-tussin cough and cold cf 117 wal-tussin dm... 107 wal-zan 75... 139 wal-zyr (cetirizine)... 58, 59 wal-zyr d... 58 warfarin... 76 water for irrigation, sterile... 165 WELCHOL... 95, 96 wera (28)... 106 womens daily gummies... 194 women's daily multivitamin. 202 X XALKORI... 36 XARELTO... 76 XELJANZ... 172 XELJANZ XR... 172 XIFAXAN... 19 XOLAIR... 186 XTANDI... 36 xulane... 106 xylon 10... 10 XYREM... 187 Y yelets... 209 YERVOY... 37 YF-VAX (PF)... 164 YONDELIS... 37 Z zafirlukast... 183 zaleplon... 187 ZANTAC... 139 ZANTAC 75... 139 zarah... 106 ZARXIO... 77 ZAVESCA... 128 zebutal... 10 ZELBORAF... 37 ZEMPLAR... 166 zenatane... 120 zenchent (28)... 106 ZENPEP... 129 ZEPATIER... 73 zephrex-d... 117 ZETIA... 96 ZIAGEN... 72 zidovudine... 72 zinc oxide... 120 ziprasidone hcl... 68 ZIRGAN... 135 ZOLADEX... 37 zoledronic acid... 166 zoledronic acid-mannitol-water... 166 ZOLINZA... 37 zolmitriptan... 60 zolpidem... 187, 188 ZOMETA... 166 ZONATUSS... 117 zonisamide... 41 zoo chews... 209 ZORTRESS... 159 ZOSTAVAX (PF)... 164 zovia 1/35e (28)... 106 I-23 www.centersplan.com/fida/participants

zovia 1/50e (28)... 107 ZOVIRAX... 120 z-sleep... 57 ZUBSOLV... 16 ZYDELIG... 37 ZYKADIA... 37 ZYLET... 135 zyncof... 117 ZYPREXA RELPREVV... 68 ZYRTEC... 59 ZYTIGA... 37 ZYVOX... 19 I-24 www.centersplan.com/fida/participants

FOR HEALTHY LIVING CENTERS PLAN 中央計劃管理式長期護理護士服務 Centers Plan for FIDA Care Complete 電話 :1-800-466-2745( 免費電話 ) TTY:1-800-421-1220 工作時間 : 每週七天, 早 8 點至晚 8 點電子郵件地址 :CustomerCareGroup@centersplan.com 網址 :www.centersplan.com/fida/participants

2026 © docsplayer.com 隐私 | 条款 | 反馈