4 Tier RX Plan

The 4 tier drug program will help you better control the high cost associated with prescription drug benefits. The plan offers access to a revolutionary 4 tier program to help you save money on all your prescription needs. Through our nationwide network of over 50,000 participating pharmacies you now have access to a 4 tier prescription plan.

PREFERRED DRUG LIST UPDATES: For the most up-to-date information about the Preferred Drug List, please see the information on our website. This Preferred Drug List includes most, but not all, therapeutic classes of prescription drugs and is subject to change at any time upon review. Our Preferred Drug List is reviewed each month. Physicians and Pharmacist are encouraged to review the Preferred Drug List and utilize it when prescribing for our members. This is extremely important since a member’s prescription benefit is based on medication being prescribed for the Preferred Drug List. The Preferred Drug List is not intended to interfere with independent medical judgment that is based upon the patient-physician relationship. The final choice of specific drug selection for an individual patient rests solely with the prescriber.

GENERIC DRUG POLICY: It is our policy to utilize high quality generic medications when available. A generic drug is identical or bioequivalent, to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts for the brand name price. It is our policy to encourage pharmacies to utilize the same generic product that was distributed by the same company that was dispensed on the original prescription on all subsequent refills for the drug product selection. We do not recommend that generic substituting be exercised with multisource products that cannot be considered therapeutically equivalent to others in the same category It is also recommended that generic substitution not be undertaken for any unrated products that might be considered narrow therapeutic index (NTI) drugs or which are known not to be bioequivalent. Finally, it is important to note that state laws and regulations govern the practice of generic substituting for certain drug products. Requests for exception to the generic policy must clearly document specific reasons for medical necessity and appropriateness.

Medications that have generic equivalents available are covered at a generic reimbursement level and should be prescribed and dispensed in generic form. Maximum Allowable Cost (MAC) limits have been established for specific dosage forms of these drugs. The MAC list sets a ceiling price for the reimbursement of certain multisource prescription drugs. This price will typically cover the acquisition of most generic but not branded versions of the same drug. The products selected for inclusion on the MAC list are commonly prescribed and dispensed and have gone through FDA’s review and approval process.

EXCLUSIONS & LIMITATIONS: Any medication or drug that has not been approved by the FDA to be both effective for use in the United States will not be covered. This includes both FDA approved and non-approved medications that are in experimental or investigational trials to determine new indications, new routes or administration, or new dosage forms. This Prescription Drug Card Is Not Insurance. Formulary is subject to change without notice. For the most up-to-date information about the Preferred Drug List, please see the information on our website.

4 Tier RX Plan PDF

Price Sheet

Consist of Generic Drugs that can be purchased for $10.00 or less.

Tier 01: < $10

Consist of Brand Name and Generic Drugs that can be purchased for $20.00 or less.

Tier 02: < $20

Consist of Brand Name and Select Generic Drugs that can be purchased for $40.00 or less.

Tier 03: < $40

Consist of Brand Name and Select Generic Drugs that can be purchased for a special discounted price.

Tier 04: Special

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special ABILIFY 10MG - TABLET 30 $303.86Tier 04 Special ABILIFY 15MG - TABLET 30 $303.86Tier 04 Special ABILIFY 5MG - TABLET 30 $303.86Tier 04 Special ACAPELLA - EACH 1 $47.52Tier 03 Under $40 ACCOLATE 20MG - TABLET 30 $36.70Tier 03 Under $40 ACCU-CHEK - KIT 1 $31.17Tier 03 Under $40 ACCU-CHEK - STRIP 50 $25.96Tier 04 Special ACCUHIST LA 20-8MG - TABLET, SUSTAINED RELEASE 12HR 30 $41.45Tier 04 Special ACCUHIST PDX 3-12.5-1/1 - DROPS 30 $41.98Tier 03 Under $40 ACCUHIST PDX 50-5-5-2/5 - SYRUP 240 $31.68Tier 03 Under $40 ACCUNEB 0.21MG/ML - SOLUTION, NON-ORAL 75 $38.28Tier 03 Under $40 ACCUNEB 0.42MG/ML - SOLUTION, NON-ORAL 75 $38.28Tier 03 Under $40 ACCUPRIL 10MG - TABLET 30 $37.75Tier 03 Under $40 ACCUPRIL 20MG - TABLET 30 $37.14Tier 03 Under $40 ACCUPRIL 40MG - TABLET 30 $37.14Tier 03 Under $40 ACCURETIC 20-12.5MG - TABLET 30 $36.43Tier 03 Under $40 ACCURETIC 20-25MG - TABLET 30 $37.75Tier 04 Special ACCUTANE 40MG - CAPSULE (HARD, SOFT, ETC.) 30 $395.21Tier 02 Under $20 ACEBUTOLOL HCL 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $13.10Tier 04 Special ACEON 4MG - TABLET 30 $42.77Tier 01 Under $10 ACETAMINOPHEN W/BUTALBITAL 325-50MG - TABLET 30 $9.36Tier 01 Under $10 ACETAMINOPHEN W/CODEINE 12-120MG/5 - ELIXIR 60 $1.36Tier 01 Under $10 ACETAMINOPHEN W/CODEINE 30-300MG - TABLET 30 $6.29Tier 02 Under $20 ACETAMINOPHEN W/CODEINE 60-300MG - TABLET 30 $11.08Tier 03 Under $40 ACETASOL HC 2-1% - DROPS 10 $22.40Tier 01 Under $10 ACETAZOLAMIDE 250MG - TABLET 30 $6.40Tier 04 Special ACIPHEX 20MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $123.82Tier 03 Under $40 ACLOVATE 0.05% - CREAM (GRAMS) 30 $39.86Tier 03 Under $40 ACLOVATE 0.05% - OINTMENT(GM) 30 $39.86Tier 04 Special ACTIQ 400MCG - LOLLIPOP 120 $1,232.35Tier 04 Special ACTIQ 600MCG - LOLLIPOP 120 $1,560.42Tier 03 Under $40 ACTIVELLA 1-0.5MG - TABLET 30 $38.31Tier 04 Special ACTONEL 35MG - TABLET 30 $505.20Tier 04 Special ACTOS 15MG - TABLET 30 $99.53Tier 04 Special ACTOS 30MG - TABLET 30 $159.19Tier 04 Special ACTOS 45MG - TABLET 30 $172.66Tier 01 Under $10 ACYCLOVIR 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $6.39Tier 03 Under $40 ACYCLOVIR 200MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 115 $22.81Tier 01 Under $10 ACYCLOVIR 400MG - TABLET 30 $9.19Tier 03 Under $40 ACYCLOVIR 800MG - TABLET 30 $25.99Tier 04 Special ADDERALL XR 10MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.08Tier 04 Special ADDERALL XR 15MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.08Tier 04 Special ADDERALL XR 20MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.08Tier 04 Special ADDERALL XR 25MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.08Tier 04 Special ADDERALL XR 30MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.08

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Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special ADDERALL XR 5MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.08Tier 04 Special ADDERALL XR 5MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.08Tier 04 Special ADOXA 100MG - TABLET 30 $116.16Tier 04 Special ADVAIR DISKUS 100-50MCG - DISK, WITH INHALATION DEVICE 60 $117.22Tier 04 Special ADVAIR DISKUS 250-50MCG - DISK, WITH INHALATION DEVICE 60 $148.37Tier 04 Special ADVAIR DISKUS 500-50MCG - DISK, WITH INHALATION DEVICE 60 $205.39Tier 04 Special ADVICOR 1000-20MG - TABLET, MULTIPHASIC RELEASE 30 $76.30Tier 04 Special ADVICOR 500-20MG - TABLET, MULTIPHASIC RELEASE 30 $65.47Tier 04 Special ADVICOR 500-20MG - TABLET, MULTIPHASIC RELEASE 30 $71.54Tier 04 Special AEROBID-M 250MCG - AEROSOL W/ADAPTER (GM) 7 $71.09Tier 03 Under $40 AEROCHAMBER - INHALER (EA) 1 $32.30Tier 03 Under $40 AFEDITAB CR 30MG - TABLET, SUSTAINED ACTION 30 $24.37Tier 04 Special AKNE-MYCIN 2% - OINTMENT(GM) 25 $52.14Tier 01 Under $10 ALBUTEROL 90MCG - AEROSOL (GM) 17 $9.29Tier 01 Under $10 ALBUTEROL SULFATE 0.83MG/ML - SOLUTION, NON-ORAL 72 $5.90Tier 01 Under $10 ALBUTEROL SULFATE 2MG - TABLET 30 $2.91Tier 01 Under $10 ALBUTEROL SULFATE 2MG/5ML - SYRUP 60 $3.00Tier 04 Special ALCORTIN 2%-1%-1% - GEL IN PACKET (GM) 48 $60.40Tier 04 Special ALDARA 5% - PACKET 3 $42.03Tier 03 Under $40 ALESSE-28 0.1-0.02 - TABLET 30 $36.96Tier 04 Special ALLEGRA 180MG - TABLET 30 $69.17Tier 03 Under $40 ALLEGRA 30MG - TABLET 30 $20.06Tier 03 Under $40 ALLEGRA 60MG - TABLET 30 $39.86Tier 04 Special ALLEGRA 60MG - TABLET 30 $40.04Tier 04 Special ALLEGRA-D 12 HOUR 120-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $40.92Tier 03 Under $40 ALLERX 120-8-2.5 - TABLET,SUSTAINED RELEASE 12HR SEQUENTIAL 30 $38.81Tier 04 Special ALLERX 7.5-3MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 300 $58.08Tier 03 Under $40 ALLERX-D 120-2.5MG - TABLET, SUSTAINED RELEASE 12HR 30 $27.19Tier 03 Under $40 ALLFEN 1000-150MG - TABLET, SUSTAINED RELEASE 12HR 30 $24.02Tier 03 Under $40 ALLFEN-DM 1000-50MG - TABLET, SUSTAINED RELEASE 12HR 30 $23.23Tier 03 Under $40 ALLFEN-DM 1000-55MG - TABLET, SUSTAINED RELEASE 12HR 30 $24.55Tier 01 Under $10 ALLOPURINOL 100MG - TABLET 30 $2.61Tier 01 Under $10 ALLOPURINOL 300MG - TABLET 30 $5.79Tier 04 Special ALOCRIL 2% - DROPS 5 $66.92Tier 04 Special ALPHAGAN P 0.15% - DROPS 5 $40.01Tier 01 Under $10 ALPRAZOLAM 0.25MG - TABLET 30 $1.55Tier 01 Under $10 ALPRAZOLAM 0.5MG - TABLET 30 $1.76Tier 01 Under $10 ALPRAZOLAM 1MG - TABLET 30 $2.37Tier 01 Under $10 ALPRAZOLAM 2MG - TABLET 30 $5.99Tier 03 Under $40 ALREX 0.2% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $38.72Tier 04 Special ALREX 0.2% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 10 $77.44Tier 04 Special ALTACE 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $52.93Tier 03 Under $40 ALTACE 2.5MG - CAPSULE (HARD, SOFT, ETC.) 30 $37.49Tier 04 Special ALTACE 5MG - CAPSULE (HARD, SOFT, ETC.) 30 $43.00Tier 04 Special ALTOPREV 20MG - TABLET, SUSTAINED RELEASE 24HR 30 $59.93

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Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special ALTOPREV 60MG - TABLET, SUSTAINED RELEASE 24HR 30 $66.26Tier 01 Under $10 ALUMINUM CHLORIDE 20% - SOLUTION, NON-ORAL 35 $6.93Tier 02 Under $20 ALUMINUM CHLORIDE HEXAHYDRATE 20% - SOLUTION, NON-ORAL 60 $11.72Tier 01 Under $10 AMANTADINE HCL 50MG/5ML - SYRUP 50 $4.08Tier 02 Under $20 AMARYL 1MG - TABLET 30 $11.48Tier 02 Under $20 AMARYL 2MG - TABLET 30 $18.66Tier 03 Under $40 AMARYL 4MG - TABLET 30 $35.23Tier 04 Special AMBIEN 10MG - TABLET 30 $88.97Tier 04 Special AMBIEN 5MG - TABLET 30 $72.34Tier 04 Special AMBIEN PAK 10MG - TABLET 30 $88.97Tier 02 Under $20 AMBIFED-G 1000-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $18.48Tier 04 Special AMERGE 1MG - TABLET 30 $576.58Tier 04 Special AMERGE 2.5MG - TABLET 30 $576.58Tier 01 Under $10 AMIBID DM 600-30MG - TABLET, SUSTAINED RELEASE 12HR 30 $6.05Tier 04 Special AMICAR 500MG - TABLET 30 $64.15Tier 01 Under $10 AMIDRINE 65-325-100 - CAPSULE (HARD, SOFT, ETC.) 30 $5.69Tier 01 Under $10 AMIGESIC 750MG - TABLET 30 $4.58Tier 03 Under $40 AMIODARONE HCL 200MG - TABLET 30 $29.57Tier 02 Under $20 AMI-TEX LA 600-30MG - TABLET, SUSTAINED RELEASE 12HR 30 $13.68Tier 01 Under $10 AMITRIPTYLINE HCL 100MG - TABLET 30 $4.86Tier 01 Under $10 AMITRIPTYLINE HCL 10MG - TABLET 30 $1.80Tier 01 Under $10 AMITRIPTYLINE HCL 150MG - TABLET 30 $7.34Tier 01 Under $10 AMITRIPTYLINE HCL 25MG - TABLET 30 $1.52Tier 01 Under $10 AMITRIPTYLINE HCL 50MG - TABLET 30 $2.33Tier 01 Under $10 AMITRIPTYLINE HCL 75MG - TABLET 30 $4.41Tier 01 Under $10 AMITRIPTYLINE W/PERPHENAZINE 25-2MG - TABLET 30 $3.49Tier 03 Under $40 AMMONIUM LACTATE 12% - CREAM (GRAMS) 225 $20.78Tier 04 Special AMNESTEEM 40MG - CAPSULE (HARD, SOFT, ETC.) 30 $208.25Tier 04 Special AMOX TR-POTASSIUM CLAVULANATE 500-125MG - TABLET 30 $71.80Tier 04 Special AMOX TR-POTASSIUM CLAVULANATE 875-125MG - TABLET 30 $106.74Tier 01 Under $10 AMOXICILLIN 125MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $2.24Tier 01 Under $10 AMOXICILLIN 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.52Tier 01 Under $10 AMOXICILLIN 250MG - TABLET, CHEWABLE 30 $6.67Tier 01 Under $10 AMOXICILLIN 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 80 $2.12Tier 01 Under $10 AMOXICILLIN 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $3.02Tier 02 Under $20 AMOXICILLIN 875MG - TABLET 30 $17.68Tier 01 Under $10 AMOXIL 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.59Tier 01 Under $10 AMOXIL 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $1.76Tier 02 Under $20 AMOXIL 400MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 200 $19.36Tier 01 Under $10 AMOXIL 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $3.96Tier 03 Under $40 AMPHETAMINE SALT COMBO 20MG - TABLET 30 $32.91Tier 03 Under $40 AMPHETAMINE SALT COMBO 30MG - TABLET 30 $30.25Tier 03 Under $40 AMPHETAMINE SALT COMBO 5MG - TABLET 30 $33.53Tier 01 Under $10 AMPICILLIN TRIHYDRATE 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.54Tier 01 Under $10 AMPICILLIN TRIHYDRATE 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $8.30

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Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 ANALPRAM-HC 1%-1% - CREAM (GRAMS) 30 $38.81Tier 04 Special ANALPRAM-HC 2.5%-1% - CREAM (GRAMS) 30 $40.66Tier 04 Special ANAMANTLE HC 0.5-3% - CREAM WITH APPLICATOR 98 $86.46Tier 02 Under $20 ANAPLEX HD 30-1.7-2/5 - SOLUTION, ORAL 180 $14.26Tier 01 Under $10 ANDEHIST 15-1MG/ML - DROPS 30 $7.47Tier 01 Under $10 ANDEHIST 45-4MG/5ML - SYRUP 120 $8.35Tier 01 Under $10 ANDEHIST-DM 15-45-4/5 - SYRUP 60 $4.41Tier 01 Under $10 ANDEHIST-DM 4-15-1/ML - DROPS 30 $8.83Tier 04 Special ANDROGEL 1%(12.5MG) - GEL IN METERED-DOSE PUMP 150 $187.44Tier 04 Special ANDROGEL 1%(50MG) - GEL IN PACKET (GM) 150 $187.88Tier 04 Special ANDROID 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $83.16Tier 01 Under $10 ANEMAGEN - CAPSULE (HARD, SOFT, ETC.) 30 $5.02Tier 01 Under $10 ANTIPYRINE W/BENZOCAINE 5.4-1.4% - DROPS 10 $1.89Tier 01 Under $10 ANTISPASMODIC 16.2MG/5ML - ELIXIR 100 $2.52Tier 01 Under $10 ANTISPASMODIC 16.2MG/5ML - ELIXIR 150 $3.48Tier 01 Under $10 ANUCORT-HC 25MG - SUPPOSITORY, RECTAL 6 $3.23Tier 01 Under $10 APAP/DICHLPHEN/ISOMETHEPTENE 65-325-100 - CAPSULE (HARD, SOFT, ETC.) 30 $5.94Tier 03 Under $40 APRI 0.15-0.03 - TABLET 30 $22.41Tier 04 Special ARICEPT 10MG - TABLET 30 $143.09Tier 04 Special ARIMIDEX 1MG - TABLET 30 $227.04Tier 03 Under $40 ARISTOCORT A 0.1% - CREAM (GRAMS) 30 $23.50Tier 01 Under $10 ARMOUR THYROID 120MG - TABLET 30 $7.92Tier 01 Under $10 ARMOUR THYROID 30MG - TABLET 30 $3.96Tier 01 Under $10 ARMOUR THYROID 60MG - TABLET 30 $4.22Tier 01 Under $10 ARMOUR THYROID 90MG - TABLET 30 $6.60Tier 04 Special ARTHROTEC 50 50-0.2MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $55.18Tier 04 Special ARTHROTEC 75 75-0.2MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $54.30Tier 03 Under $40 ASACOL 400MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $29.04Tier 04 Special ASCENSIA AUTODISC - STRIP 100 $76.78Tier 04 Special ASCENSIA ELITE - STRIP 100 $73.04Tier 04 Special ASCENSIA MICROFILL - STRIP 100 $77.44Tier 04 Special ASTELIN 137MCG - AEROSOL, SPRAY W/PUMP (ML) 34 $57.45Tier 04 Special ATACAND 16MG - TABLET 30 $44.88Tier 04 Special ATACAND 32MG - TABLET 30 $60.72Tier 04 Special ATACAND HCT 32-12.5MG - TABLET 30 $62.04Tier 01 Under $10 ATENOLOL 100MG - TABLET 30 $5.14Tier 01 Under $10 ATENOLOL 25MG - TABLET 30 $2.77Tier 01 Under $10 ATENOLOL 50MG - TABLET 30 $1.70Tier 02 Under $20 ATENOLOL W/CHLORTHALIDONE 100-25MG - TABLET 30 $10.76Tier 01 Under $10 ATENOLOL W/CHLORTHALIDONE 50MG-25MG - TABLET 30 $6.98Tier 03 Under $40 ATIVAN 0.5MG - TABLET 30 $26.66Tier 01 Under $10 ATROPINE SULFATE 1% - DROPS 5 $1.13Tier 04 Special ATROVENT 18MCG - AEROSOL W/ADAPTER (GM) 15 $62.57Tier 02 Under $20 ATUSS G 100-10-2/5 - SYRUP 120 $14.78Tier 02 Under $20 ATUSS MS 10-5-2MG/5 - SYRUP 120 $16.90

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Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 ATUSS NX 150-3MG/5 - SYRUP 120 $14.78Tier 04 Special AUGMENTIN 250-125MG - TABLET 30 $85.80Tier 04 Special AUGMENTIN 250-62.5/5 - SUSPENSION, RECONSTITUTED, ORAL (ML) 75 $40.26Tier 04 Special AUGMENTIN ES-600 600-42.9/5 - SUSPENSION, RECONSTITUTED, ORAL (ML) 125 $62.70Tier 04 Special AUGMENTIN XR 1000-62.5 - TABLET, SUSTAINED RELEASE 12HR 30 $80.78Tier 04 Special AVALIDE 150-12.5MG - TABLET 30 $56.94Tier 04 Special AVALIDE 300-12.5MG - TABLET 30 $60.85Tier 03 Under $40 AVANDAMET 1-500MG - TABLET 30 $32.21Tier 04 Special AVANDAMET 2-1000MG - TABLET 30 $64.15Tier 04 Special AVANDAMET 2-500MG - TABLET 30 $48.05Tier 04 Special AVANDAMET 4-1000MG - TABLET 30 $96.36Tier 04 Special AVANDAMET 4-500MG - TABLET 30 $78.41Tier 04 Special AVANDIA 2MG - TABLET 30 $58.08Tier 04 Special AVANDIA 4MG - TABLET 30 $82.90Tier 04 Special AVANDIA 8MG - TABLET 30 $153.65Tier 04 Special AVAPRO 150MG - TABLET 30 $46.24Tier 04 Special AVAPRO 300MG - TABLET 30 $55.68Tier 04 Special AVELOX 400MG - TABLET 30 $282.48Tier 04 Special AVELOX ABC PACK 400MG - TABLET 30 $282.48Tier 03 Under $40 AVIANE 0.1-0.02 - TABLET 30 $22.81Tier 04 Special AVINZA 30MG - CAPSULE, MULTIPHASIC RELEASE 30 $78.14Tier 04 Special AVINZA 90MG - CAPSULE, MULTIPHASIC RELEASE 30 $233.73Tier 04 Special AVODART 0.5MG - CAPSULE (HARD, SOFT, ETC.) 30 $78.94Tier 04 Special AXERT 12.5MG - TABLET 30 $525.62Tier 04 Special AXID 150MG/10ML - SOLUTION, ORAL 225 $108.90Tier 03 Under $40 AZATHIOPRINE 50MG - TABLET 30 $22.59Tier 04 Special AZELEX 20% - CREAM (GRAMS) 50 $82.28Tier 04 Special AZMACORT 100MCG - AEROSOL W/ADAPTER (GM) 20 $84.83Tier 03 Under $40 AZOPT 1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $32.91Tier 04 Special B & O SUPPRETTES NO.15-A 30-16.2MG - SUPPOSITORY, RECTAL 60 $180.05Tier 01 Under $10 BACITRACIN 500 UNIT/G - OINTMENT(GM) 4 $3.05Tier 03 Under $40 BACITRACIN/POLYMYXIN B - OINTMENT(GM) 4 $21.44Tier 01 Under $10 BACLOFEN 10MG - TABLET 30 $9.70Tier 02 Under $20 BACLOFEN 20MG - TABLET 30 $15.12Tier 03 Under $40 BACTROBAN 2% - CREAM (GRAMS) 15 $31.55Tier 04 Special BECONASE AQ 42MCG - AEROSOL, SPRAY, (GM) 25 $71.06Tier 01 Under $10 BELLADONNA W/PHENOBARBITAL 16.2MG - TABLET 30 $1.04Tier 01 Under $10 BELLAMINE-S 0.6-0.2-40 - TABLET 30 $8.58Tier 02 Under $20 BENAZEPRIL HCL 10MG - TABLET 30 $11.66Tier 02 Under $20 BENAZEPRIL HCL 40MG - TABLET 30 $11.09Tier 02 Under $20 BENAZEPRIL HCL 5MG - TABLET 30 $16.80Tier 02 Under $20 BENAZEPRIL HCL-HCTZ 10-12.5MG - TABLET 30 $15.12Tier 02 Under $20 BENAZEPRIL HCL-HCTZ 20-12.5MG - TABLET 30 $14.48Tier 04 Special BENICAR 20MG - TABLET 30 $44.35Tier 04 Special BENICAR 40MG - TABLET 30 $44.35

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Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special BENICAR HCT 20-12.5MG - TABLET 30 $48.84Tier 04 Special BENICAR HCT 40-12.5MG - TABLET 30 $48.84Tier 04 Special BENICAR HCT 40-25MG - TABLET 30 $48.84Tier 02 Under $20 BENTYL 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $10.30Tier 03 Under $40 BENZAC AC 5% - LIQUID (ML) 226 $37.79Tier 04 Special BENZACLIN 1-5% - GEL (GM) 25 $59.37Tier 02 Under $20 BENZONATATE 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $11.08Tier 03 Under $40 BENZONATATE 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $39.99Tier 03 Under $40 BENZOYL PEROXIDE 10% - LIQUID (ML) 227 $24.15Tier 01 Under $10 BENZTROPINE MESYLATE 0.5MG - TABLET 30 $3.84Tier 01 Under $10 BENZTROPINE MESYLATE 1MG - TABLET 30 $4.82Tier 02 Under $20 BETAMETHASONE DIPROPIONATE 0.05% - CREAM (GRAMS) 45 $10.87Tier 01 Under $10 BETAMETHASONE DIPROPIONATE 0.05% - LOTION (ML) 60 $9.60Tier 01 Under $10 BETAMETHASONE DIPROPIONATE 0.05% - OINTMENT(GM) 50 $8.40Tier 04 Special BETAMETHASONE DP AUGMENTED 0.05% - CREAM (GRAMS) 30 $47.79Tier 02 Under $20 BETAMETHASONE DP AUGMENTED 0.05% - OINTMENT(GM) 15 $11.52Tier 01 Under $10 BETAMETHASONE VALERATE 0.1% - LOTION (ML) 60 $8.83Tier 01 Under $10 BETAMETHASONE VALERATE 0.1% - OINTMENT(GM) 15 $2.66Tier 01 Under $10 BETA-VAL 0.1% - LOTION (ML) 60 $9.04Tier 03 Under $40 BETIMOL 0.5% - DROPS 5 $20.28Tier 04 Special BEXTRA 10MG - TABLET 30 $90.96Tier 04 Special BEXTRA 20MG - TABLET 30 $89.50Tier 03 Under $40 BIAXIN 125MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $38.72Tier 04 Special BIAXIN 250MG - TABLET 30 $127.78Tier 04 Special BIAXIN 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $72.78Tier 04 Special BIAXIN 500MG - TABLET 30 $130.59Tier 04 Special BIAXIN XL 500MG - TABLET, SUSTAINED RELEASE 24HR 30 $131.47Tier 03 Under $40 BICILLIN L-A 1.2MMU/2ML - DISPOSABLE SYRINGE (ML) 2 $37.68Tier 04 Special BICILLIN L-A 2.4MMU/4ML - DISPOSABLE SYRINGE (ML) 4 $77.23Tier 02 Under $20 BISOPROLOL FUMARATE/HCTZ 10-6.25MG - TABLET 30 $11.92Tier 02 Under $20 BISOPROLOL FUMARATE/HCTZ 2.5-6.25MG - TABLET 30 $11.80Tier 02 Under $20 BISOPROLOL FUMARATE/HCTZ 5-6.25MG - TABLET 30 $13.04Tier 03 Under $40 BLEPHAMIDE 10-0.2% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $38.90Tier 02 Under $20 BREATHERITE - EACH 1 $11.26Tier 02 Under $20 BRETHINE 2.5MG - TABLET 30 $13.73Tier 04 Special BREVICON 0.5-0.035 - TABLET 30 $45.14Tier 04 Special BREVOXYL-4 4% - LIQUID (ML) 170 $49.37Tier 04 Special BREVOXYL-8 8% - LIQUID (ML) 170 $50.86Tier 01 Under $10 BROMAXEFED DM RF 15-45-4/5 - SYRUP 120 $8.18Tier 01 Under $10 BROMETANE DX 10-30-2/5 - SYRUP 120 $4.42Tier 01 Under $10 BROMFENEX 120-12MG - CAPSULE, SUSTAINED ACTION 30 $9.27Tier 01 Under $10 BROMFENEX-PD 60-6MG - CAPSULE, SUSTAINED ACTION 30 $6.06Tier 01 Under $10 BROMPLEX DM 30-60-4/5 - SYRUP 90 $5.00Tier 02 Under $20 BROVEX HC 30-2.5-3/5 - SYRUP 120 $13.73Tier 03 Under $40 BROVEX-D 20-12MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 120 $28.51

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Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 BUDEPRION SR 100MG - TABLET, SUSTAINED ACTION 30 $39.73Tier 03 Under $40 BUDEPRION SR 150MG - TABLET, SUSTAINED ACTION 30 $35.28Tier 01 Under $10 BUMETANIDE 0.5MG - TABLET 30 $6.51Tier 01 Under $10 BUMETANIDE 1MG - TABLET 30 $8.76Tier 01 Under $10 BUPROPION HCL 100MG - TABLET 30 $9.49Tier 03 Under $40 BUPROPION HCL 100MG - TABLET, SUSTAINED ACTION 30 $36.40Tier 04 Special BUPROPION HCL 150MG - TABLET, SUSTAINED ACTION 30 $43.93Tier 02 Under $20 BUPROPION HCL 75MG - TABLET 30 $11.18Tier 01 Under $10 BUSPIRONE HCL 10MG - TABLET 30 $7.90Tier 02 Under $20 BUSPIRONE HCL 15MG - TABLET 30 $10.82Tier 04 Special BUSPIRONE HCL 30MG - TABLET 30 $40.76Tier 01 Under $10 BUSPIRONE HCL 5MG - TABLET 30 $4.49Tier 01 Under $10 BUTALBITAL/APAP/CAFFEINE 325-40-50 - TABLET 30 $7.20Tier 03 Under $40 BUTALBITAL/CAFF/APAP/CODEINE 30-325-50 - CAPSULE (HARD, SOFT, ETC.) 30 $24.80Tier 01 Under $10 BUTALBITAL-APAP-CAFFEINE 325-40-50 - TABLET 30 $6.98Tier 03 Under $40 BUTALBITAL-CAFF-APAP-CODEINE 30-325-50 - CAPSULE (HARD, SOFT, ETC.) 30 $35.15Tier 04 Special BUTORPHANOL TARTRATE 10MG/ML - AEROSOL, SPRAY (ML) 3 $53.67Tier 04 Special CADUET 10-20MG - TABLET 30 $130.15Tier 04 Special CADUET 5MG-40MG - TABLET 30 $130.15Tier 03 Under $40 CAMILA 0.35MG - TABLET 30 $27.86Tier 02 Under $20 CAMPRAL 333MG - TABLET, DOSE PACK 30 $19.27Tier 04 Special CANASA 500MG - SUPPOSITORY, RECTAL 12 $57.24Tier 04 Special CAPEX SHAMPOO 0.01% - SHAMPOO 120 $52.80Tier 01 Under $10 CAPTOPRIL 12.5MG - TABLET 30 $1.47Tier 01 Under $10 CAPTOPRIL 25MG - TABLET 30 $1.58Tier 01 Under $10 CAPTOPRIL 50MG - TABLET 30 $3.35Tier 01 Under $10 CAPTOPRIL/HYDROCHLOROTHIAZIDE 25MG-15MG - TABLET 30 $7.76Tier 02 Under $20 CAPTOPRIL/HYDROCHLOROTHIAZIDE 50MG-15MG - TABLET 30 $11.62Tier 04 Special CARAC 0.5% - CREAM (GRAMS) 30 $96.89Tier 02 Under $20 CARAFATE 1G/10ML - SUSPENSION, ORAL (FINAL DOSE FORM) 130 $13.73Tier 01 Under $10 CARBAMAZEPINE 200MG - TABLET 30 $4.59Tier 03 Under $40 CARBATROL 200MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $29.30Tier 03 Under $40 CARBATROL 300MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $29.30Tier 01 Under $10 CARBAXEFED DM RF 4-15-1/ML - DROPS 30 $8.83Tier 02 Under $20 CARBIDOPA/LEVODOPA 25MG-100MG - TABLET 30 $13.68Tier 02 Under $20 CARBIHIST 4MG/5ML - LIQUID (ML) 118 $12.50Tier 01 Under $10 CARBOFED DM 15-45-4/5 - SYRUP 90 $6.62Tier 01 Under $10 CARBOFED DM 4-15-1/ML - DROPS 30 $8.57Tier 03 Under $40 CAR-B-PEN TA/CHLOR-TAN 60-5MG - TABLET 30 $30.03Tier 01 Under $10 CARDEC 15-1MG/ML - DROPS 30 $7.47Tier 01 Under $10 CARDEC DM 15-45-4/5 - SYRUP 100 $7.35Tier 04 Special CARDIZEM CD 180MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $48.05Tier 04 Special CARDIZEM CD 360MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $91.87Tier 03 Under $40 CARDIZEM LA 120MG - TABLET, SUSTAINED RELEASE 24HR 30 $35.11Tier 03 Under $40 CARDIZEM LA 180MG - TABLET, SUSTAINED RELEASE 24HR 30 $39.07

7

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special CARDIZEM LA 240MG - TABLET, SUSTAINED RELEASE 24HR 30 $42.24Tier 04 Special CARDIZEM LA 360MG - TABLET, SUSTAINED RELEASE 24HR 30 $64.42Tier 01 Under $10 CARISOPRODOL 350MG - TABLET 30 $1.64Tier 04 Special CARMOL HC 1% - CREAM (GRAMS) 85 $77.79Tier 03 Under $40 CARTIA XT 120MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $30.15Tier 03 Under $40 CARTIA XT 180MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $28.38Tier 04 Special CARTIA XT 240MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $45.16Tier 04 Special CASODEX 50MG - TABLET 30 $401.02Tier 04 Special CATAPRES-TTS 1 0.1MG/24HR - PATCH, TRANSDERMAL WEEKLY 4 $58.22Tier 04 Special CATAPRES-TTS 3 0.3MG/24HR - PATCH, TRANSDERMAL WEEKLY 4 $132.77Tier 04 Special CEDAX 400MG - CAPSULE (HARD, SOFT, ETC.) 30 $239.98Tier 04 Special CEDAX 90MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 60 $40.13Tier 02 Under $20 CEFACLOR 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $19.13Tier 03 Under $40 CEFACLOR 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 150 $31.46Tier 03 Under $40 CEFACLOR 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $38.10Tier 04 Special CEFADROXIL 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $68.91Tier 04 Special CEFPODOXIME PROXETIL 100MG - TABLET 30 $104.04Tier 04 Special CEFTIN 125MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $44.88Tier 03 Under $40 CEFTIN 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 50 $34.76Tier 04 Special CEFUROXIME 250MG - TABLET 30 $79.99Tier 04 Special CEFUROXIME 500MG - TABLET 30 $122.81Tier 04 Special CEFUROXIME AXETIL 250MG - TABLET 30 $80.08Tier 04 Special CEFUROXIME AXETIL 500MG - TABLET 30 $122.83Tier 04 Special CEFZIL 125MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $41.36Tier 04 Special CEFZIL 250MG - TABLET 30 $127.34Tier 03 Under $40 CEFZIL 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 50 $37.95Tier 04 Special CEFZIL 500MG - TABLET 30 $263.47Tier 04 Special CELEBREX 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $51.35Tier 04 Special CELEBREX 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $83.98Tier 04 Special CELEBREX 400MG - CAPSULE (HARD, SOFT, ETC.) 30 $126.32Tier 04 Special CELEXA 20MG - TABLET 30 $75.24Tier 04 Special CELEXA 40MG - TABLET 30 $78.41Tier 04 Special CELLCEPT 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $85.54Tier 04 Special CELLCEPT 500MG - TABLET 30 $170.81Tier 03 Under $40 CENESTIN 0.625MG - TABLET 30 $30.32Tier 03 Under $40 CENESTIN 0.9MG - TABLET 30 $35.38Tier 03 Under $40 CENESTIN 1.25MG - TABLET 30 $35.38Tier 02 Under $20 CENOGEN ULTRA 106-1MG - CAPSULE (HARD, SOFT, ETC.) 30 $11.09Tier 01 Under $10 CEPHALEXIN 125MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $7.53Tier 01 Under $10 CEPHALEXIN 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $7.48Tier 02 Under $20 CEPHALEXIN 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $14.99Tier 01 Under $10 CEPHALEXIN 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $5.30Tier 01 Under $10 CHLORAL HYDRATE 500MG/5ML - SYRUP 8 $0.15Tier 01 Under $10 CHLORHEXIDINE GLUCONATE 1.2MG/ML - LIQUID (ML) 480 $6.88Tier 02 Under $20 CHLORPROMAZINE HCL 25MG - TABLET 30 $11.16

8

Tier Tier Price Drug Name and Dosage Qty PriceTier 01 Under $10 CHLORTHALIDONE 25MG - TABLET 30 $2.10Tier 01 Under $10 CHLORZOXAZONE 500MG - TABLET 30 $3.51Tier 04 Special CHOLESTYRAMINE 4G - PACKET 60 $70.84Tier 04 Special CHOLESTYRAMINE LIGHT 4G - PACKET 60 $50.04Tier 03 Under $40 CHROMAGEN 70-150-10 - CAPSULE (HARD, SOFT, ETC.) 30 $21.65Tier 03 Under $40 CHROMAGEN FORTE 151-60-1MG - CAPSULE (HARD, SOFT, ETC.) 30 $21.91Tier 04 Special CIALIS 10MG - TABLET 30 $297.53Tier 04 Special CIALIS 20MG - TABLET 30 $297.53Tier 04 Special CILOXAN 0.3% - DROPS 5 $48.75Tier 01 Under $10 CIMETIDINE 300MG - TABLET 30 $4.96Tier 01 Under $10 CIMETIDINE 400MG - TABLET 30 $3.06Tier 02 Under $20 CIMETIDINE 800MG - TABLET 30 $10.34Tier 02 Under $20 CIMETIDINE HCL 300MG/5ML - LIQUID (ML) 150 $17.91Tier 04 Special CIPRO 250MG - TABLET 30 $134.64Tier 04 Special CIPRO 500MG - TABLET 30 $157.87Tier 04 Special CIPRO 500MG/5ML - SUSPENSION, MICROCAPSULE RECONSTITUTED 100 $115.28Tier 04 Special CIPRO HC 0.2-1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 10 $79.55Tier 04 Special CIPRO XR 1000MG - TABLET, SUSTAINED RELEASE 24HR 30 $260.30Tier 04 Special CIPRO XR 500MG - TABLET, SUSTAINED RELEASE 24HR 30 $228.62Tier 04 Special CIPRODEX 0.3-0.1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 8 $85.44Tier 02 Under $20 CIPROFLOXACIN HCL 250MG - TABLET 30 $11.18Tier 02 Under $20 CIPROFLOXACIN HCL 500MG - TABLET 30 $14.06Tier 02 Under $20 CIPROFLOXACIN HCL 750MG - TABLET 30 $14.18Tier 03 Under $40 CITALOPRAM HBR 20MG - TABLET 30 $38.43Tier 04 Special CITALOPRAM HBR 40MG - TABLET 30 $47.66Tier 02 Under $20 CITRACAL PRENATAL RX 27-1MG - TABLET 30 $10.56Tier 04 Special CLARAVIS 40MG - CAPSULE (HARD, SOFT, ETC.) 30 $208.25Tier 03 Under $40 CLARINEX 2.5MG/5ML - SYRUP 150 $36.96Tier 04 Special CLARINEX 5MG - TABLET 30 $67.85Tier 04 Special CLARIPEL 4% - CREAM (GRAMS) 45 $114.05Tier 02 Under $20 CLEMASTINE FUMARATE 2.68MG - TABLET 30 $10.23Tier 03 Under $40 CLENIA 10%-5% - CLEANSER (GM) 170 $33.64Tier 04 Special CLEOCIN 100MG - SUPPOSITORY, VAGINAL 3 $46.61Tier 04 Special CLEOCIN 100MG - SUPPOSITORY, VAGINAL 10 $156.20Tier 04 Special CLEOCIN 2% - CREAM WITH APPLICATOR 40 $48.72Tier 03 Under $40 CLEOCIN PALMITATE 75MG/5ML - SOLUTION, RECONSTITUTED, ORAL 100 $25.52Tier 04 Special CLEOCIN T 1% - LOTION (ML) 60 $59.66Tier 01 Under $10 CLIDINIUM W/CHLORDIAZEPOXIDE 2.5-5MG - CAPSULE (HARD, SOFT, ETC.) 30 $1.94Tier 03 Under $40 CLIMARA .025MG/24H - PATCH, TRANSDERMAL WEEKLY 4 $33.55Tier 03 Under $40 CLIMARA .0375MG/24 - PATCH, TRANSDERMAL WEEKLY 4 $33.55Tier 03 Under $40 CLIMARA .075MG/24H - PATCH, TRANSDERMAL WEEKLY 4 $33.55Tier 03 Under $40 CLIMARA 0.05MG/24H - PATCH, TRANSDERMAL WEEKLY 4 $33.55Tier 03 Under $40 CLIMARA 0.06MG/24H - PATCH, TRANSDERMAL WEEKLY 4 $33.55Tier 03 Under $40 CLIMARA 0.1MG/24HR - PATCH, TRANSDERMAL WEEKLY 4 $33.55Tier 03 Under $40 CLIMARA PRO 45-15/24H - PATCH, TRANSDERMAL WEEKLY 4 $33.55

9

Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 CLINAC BPO 7% - GEL (GM) 45 $33.26Tier 04 Special CLINDAGEL 1% - GEL (ML) 75 $102.30Tier 03 Under $40 CLINDAMAX 1% - LOTION (ML) 60 $31.83Tier 02 Under $20 CLINDAMYCIN HCL 150MG - CAPSULE (HARD, SOFT, ETC.) 30 $19.58Tier 04 Special CLINDAMYCIN HCL 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $66.58Tier 03 Under $40 CLINDAMYCIN PHOSPHATE 1% - GEL (GM) 30 $29.03Tier 04 Special CLINDAMYCIN PHOSPHATE 1% - LOTION (ML) 60 $43.06Tier 02 Under $20 CLINDAMYCIN PHOSPHATE 1% - SOLUTION, NON-ORAL 60 $13.07Tier 03 Under $40 CLINDAMYCIN PHOSPHATE 1% - SWAB, MEDICATED 60 $37.18Tier 04 Special CLINDESSE 2% - CREAM, SUSTAINED RELEASE (GM) 6 $59.77Tier 04 Special CLOBETASOL PROPIONATE 0.05% - CREAM (GRAMS) 60 $50.67Tier 02 Under $20 CLOBETASOL PROPIONATE 0.05% - OINTMENT(GM) 15 $11.17Tier 03 Under $40 CLOBETASOL PROPIONATE 0.05% - SOLUTION, NON-ORAL 50 $31.03Tier 04 Special CLOBEX 0.05% - LOTION (ML) 59 $118.90Tier 04 Special CLOBEX 0.05% - SHAMPOO 118 $114.22Tier 04 Special CLODERM 0.1% - CREAM (GRAMS) 45 $52.67Tier 02 Under $20 CLOMIPRAMINE HCL 25MG - CAPSULE (HARD, SOFT, ETC.) 30 $12.69Tier 03 Under $40 CLOMIPRAMINE HCL 75MG - CAPSULE (HARD, SOFT, ETC.) 30 $21.28Tier 01 Under $10 CLONAZEPAM 0.5MG - TABLET 30 $2.38Tier 01 Under $10 CLONAZEPAM 1MG - TABLET 30 $0.95Tier 01 Under $10 CLONAZEPAM 2MG - TABLET 30 $5.74Tier 01 Under $10 CLONIDINE HCL 0.1MG - TABLET 30 $2.98Tier 01 Under $10 CLONIDINE HCL 0.2MG - TABLET 30 $4.67Tier 01 Under $10 CLONIDINE HCL 0.3MG - TABLET 30 $5.09Tier 02 Under $20 CLORAZEPATE DIPOTASSIUM 3.75MG - TABLET 30 $16.52Tier 02 Under $20 CLORAZEPATE DIPOTASSIUM 7.5MG - TABLET 30 $15.48Tier 01 Under $10 CLOTRIMAZOLE 1% - CREAM (GRAMS) 30 $9.74Tier 02 Under $20 CLOTRIMAZOLE/BETAMETHASONE 1-0.05% - CREAM (GRAMS) 15 $15.62Tier 02 Under $20 CLOTRIMAZOLE-BETAMETHASONE 1-0.05% - CREAM (GRAMS) 15 $14.84Tier 01 Under $10 CODAL-DH 5-1.66MG/5 - SYRUP 120 $3.74Tier 03 Under $40 COLAZAL 750MG - CAPSULE (HARD, SOFT, ETC.) 30 $35.11Tier 01 Under $10 COLCHICINE 0.6MG - TABLET 30 $4.51Tier 01 Under $10 COLCHICINE 0.6MG - TABLET 30 $5.88Tier 03 Under $40 COLDEC TR 120-8MG - TABLET, SUSTAINED RELEASE 12HR 30 $29.75Tier 03 Under $40 COMBIPATCH .05-.14/24 - PATCH, TRANSDERMAL BIWEEKLY 8 $36.21Tier 03 Under $40 COMBIPATCH .05-.25/24 - PATCH, TRANSDERMAL BIWEEKLY 8 $36.58Tier 04 Special COMBIVENT 103-18MCG - AEROSOL W/ADAPTER (GM) 15 $71.30Tier 04 Special COMBIVIR 150-300MG - TABLET 30 $323.66Tier 04 Special CONCERTA 18MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $83.95Tier 04 Special CONCERTA 27MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $85.80Tier 04 Special CONCERTA 36MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $88.44Tier 04 Special CONCERTA 54MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $96.36Tier 04 Special CONDYLOX 0.5% - GEL (GM) 4 $184.59Tier 04 Special COPAXONE 20MG - KIT 1 $1,265.10Tier 04 Special COPEGUS 200MG - TABLET 30 $200.90

10

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special CORDRAN 4MCG/SQ CM - TAPE, MEDICATED 1 $50.10Tier 04 Special COREG 12.5MG - TABLET 30 $50.42Tier 04 Special COREG 25MG - TABLET 30 $50.42Tier 04 Special COREG 3.125MG - TABLET 30 $50.42Tier 04 Special COREG 6.25MG - TABLET 30 $50.42Tier 04 Special CORGARD 40MG - TABLET 30 $58.34Tier 02 Under $20 CORTEF 10MG - TABLET 30 $11.35Tier 01 Under $10 CORTEF 5MG - TABLET 30 $6.69Tier 02 Under $20 CORTISONE ACETATE 25MG - TABLET 30 $10.81Tier 04 Special CORTISPORIN-TC 3.3-3-10/1 - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 10 $60.28Tier 04 Special CORZIDE 40-5MG - TABLET 30 $55.97Tier 04 Special COSOPT 0.5-2% - DROPS 5 $49.06Tier 01 Under $10 COUGHTUSS 5-5-2MG/5 - LIQUID (ML) 120 $4.98Tier 02 Under $20 COUGHTUSS 5-5-2MG/5 - LIQUID (ML) 240 $10.05Tier 03 Under $40 COUMADIN 10MG - TABLET 30 $33.13Tier 03 Under $40 COUMADIN 1MG - TABLET 30 $21.38Tier 03 Under $40 COUMADIN 2MG - TABLET 30 $22.44Tier 03 Under $40 COUMADIN 3MG - TABLET 30 $22.70Tier 03 Under $40 COUMADIN 4MG - TABLET 30 $23.38Tier 03 Under $40 COUMADIN 5MG - TABLET 30 $23.50Tier 03 Under $40 COUMADIN 6MG - TABLET 30 $30.89Tier 03 Under $40 COUMADIN 7.5MG - TABLET 30 $32.12Tier 04 Special COZAAR 100MG - TABLET 30 $64.60Tier 04 Special COZAAR 25MG - TABLET 30 $47.92Tier 04 Special COZAAR 50MG - TABLET 30 $47.26Tier 04 Special COZAAR 50MG - TABLET 30 $47.28Tier 03 Under $40 CRANTEX ER 300-10MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $20.33Tier 02 Under $20 CRANTEX LA 600-30MG - TABLET, SUSTAINED RELEASE 12HR 30 $13.68Tier 03 Under $40 CREON 10 249MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $26.66Tier 04 Special CREON 20 497MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $51.48Tier 04 Special CRESTOR 10MG - TABLET 30 $77.88Tier 04 Special CRESTOR 20MG - TABLET 30 $77.88Tier 04 Special CRESTOR 5MG - TABLET 30 $77.88Tier 04 Special CRINONE 8% - GEL WITH PREFILLED APPLICATOR (GM) 20 $137.63Tier 03 Under $40 CROMOLYN SODIUM 20MG/2ML - AMPUL FOR NEBULIZATION (ML) 120 $24.34Tier 03 Under $40 CRYSELLE 0.3-0.03MG - TABLET 30 $23.03Tier 03 Under $40 C-TANNA 12 30-4MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 120 $29.39Tier 03 Under $40 CYCLESSA 7 DAYS X 3 - TABLET 30 $38.81Tier 01 Under $10 CYCLOBENZAPRINE HCL 10MG - TABLET 30 $6.45Tier 04 Special CYMBALTA 20MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $83.95Tier 04 Special CYMBALTA 30MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $93.98Tier 04 Special CYMBALTA 60MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $93.98Tier 02 Under $20 CYPROHEPTADINE HCL 2MG/5ML - SYRUP 150 $12.34Tier 01 Under $10 CYPROHEPTADINE HCL 4MG - TABLET 30 $9.35Tier 03 Under $40 CYTOMEL 25MCG - TABLET 30 $22.44

11

Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 CYTOMEL 5MCG - TABLET 30 $18.22Tier 03 Under $40 CYTOTEC 100MCG - TABLET 30 $27.72Tier 01 Under $10 DALLERGY 10-2-0.625 - SYRUP 120 $3.17Tier 01 Under $10 DALLERGY 10-4-1.25 - TABLET 30 $8.18Tier 02 Under $20 DALLERGY 20-12-2.5 - TABLET, SUSTAINED RELEASE 12HR 30 $13.99Tier 02 Under $20 DALLERGY-JR 20-4MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $12.67Tier 01 Under $10 DAPSONE 100MG - TABLET 30 $5.54Tier 03 Under $40 DARVOCET-N 100 100-650MG - TABLET 30 $31.42Tier 04 Special DDAVP 0.1MG/ML - AEROSOL, SPRAY W/PUMP (ML) 5 $153.30Tier 04 Special DDAVP 0.2MG - TABLET 30 $110.88Tier 02 Under $20 DECADRON 0.5MG - TABLET 30 $17.16Tier 01 Under $10 DE-CHLOR MR 5-5-5MG/5 - SYRUP 60 $3.84Tier 01 Under $10 DE-CHLOR NX 150-3MG/5 - SYRUP 120 $9.50Tier 01 Under $10 DECONGESTANT II 600MG-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $2.45Tier 01 Under $10 DE-CONGESTINE TR 120-8MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $3.16Tier 04 Special DELATESTRYL 200MG/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 5 $83.16Tier 04 Special DELESTROGEN 20MG/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 5 $90.86Tier 03 Under $40 DEMEROL 50MG - TABLET 30 $28.51Tier 04 Special DEMEROL 50MG/5ML - SYRUP 200 $45.76Tier 03 Under $40 DENAVIR 1% - CREAM (GRAMS) 2 $32.79Tier 03 Under $40 DEPAKOTE 250MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $35.90Tier 04 Special DEPAKOTE 500MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $66.00Tier 03 Under $40 DEPAKOTE ER 250MG - TABLET, SUSTAINED RELEASE 24HR 30 $35.57Tier 04 Special DEPAKOTE ER 500MG - TABLET, SUSTAINED RELEASE 24HR 30 $62.18Tier 04 Special DEPO-PROVERA 150MG/ML - DISPOSABLE SYRINGE (ML) 1 $53.51Tier 04 Special DEPO-PROVERA 150MG/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 1 $53.17Tier 04 Special DEPO-TESTOSTERONE 200MG/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $101.73Tier 03 Under $40 DERMA-SMOOTHE/FS 0.01% - OIL 118 $32.92Tier 03 Under $40 DERMATOP 0.1% - CREAM (GRAMS) 15 $20.06Tier 02 Under $20 DERMATOP 0.1% - OINTMENT(GM) 15 $19.01Tier 03 Under $40 DESIPRAMINE HCL 100MG - TABLET 30 $21.60Tier 01 Under $10 DESIPRAMINE HCL 10MG - TABLET 30 $9.00Tier 03 Under $40 DESOGEN 0.15-0.03 - TABLET 30 $33.53Tier 01 Under $10 DESONIDE 0.05% - CREAM (GRAMS) 15 $4.74Tier 01 Under $10 DESONIDE 0.05% - OINTMENT(GM) 15 $6.19Tier 02 Under $20 DESOXIMETASONE 0.25% - CREAM (GRAMS) 15 $14.73Tier 02 Under $20 DESQUAM-E 2.5% - GEL (GM) 43 $11.73Tier 03 Under $40 DESQUAM-X 10 10% - GEL (GM) 90 $22.18Tier 04 Special DETROL LA 2MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $85.01Tier 04 Special DETROL LA 4MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $90.40Tier 01 Under $10 DEXAMETHASONE 0.5MG - TABLET 30 $2.69Tier 01 Under $10 DEXAMETHASONE 0.75MG - TABLET 30 $4.07Tier 01 Under $10 DEXAMETHASONE 1MG - TABLET 30 $8.45Tier 01 Under $10 DEXAMETHASONE 4MG - TABLET 30 $6.60Tier 03 Under $40 DEXEDRINE 10MG - CAPSULE, SUSTAINED ACTION 30 $36.17

12

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special DEXEDRINE 15MG - CAPSULE, SUSTAINED ACTION 30 $46.46Tier 03 Under $40 DEXPAK 1.5MG - TABLET, DOSE PACK 30 $24.55Tier 01 Under $10 DEXTROAMPHETAMINE SULFATE 10MG - TABLET 30 $8.94Tier 01 Under $10 DEXTROAMPHETAMINE SULFATE 5MG - TABLET 30 $5.52Tier 02 Under $20 DEXTROSTAT 10MG - TABLET 30 $13.20Tier 04 Special DIAMOX SEQUELS 500MG - CAPSULE, SUSTAINED ACTION 30 $50.69Tier 04 Special DIASTAT 10MG - KIT 1 $215.29Tier 01 Under $10 DIAZEPAM 10MG - TABLET 30 $1.62Tier 01 Under $10 DIAZEPAM 2MG - TABLET 30 $1.43Tier 01 Under $10 DIAZEPAM 5MG - TABLET 30 $0.65Tier 03 Under $40 DICLOFENAC POTASSIUM 50MG - TABLET 30 $28.11Tier 03 Under $40 DICLOFENAC SODIUM 100MG - TABLET, SUSTAINED RELEASE 24HR 30 $36.90Tier 02 Under $20 DICLOFENAC SODIUM 50MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $14.90Tier 02 Under $20 DICLOFENAC SODIUM 75MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $14.49Tier 02 Under $20 DICLOXACILLIN SODIUM 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $12.99Tier 03 Under $40 DICLOXACILLIN SODIUM 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $20.69Tier 01 Under $10 DICYCLOMINE HCL 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $3.43Tier 01 Under $10 DICYCLOMINE HCL 20MG - TABLET 30 $4.05Tier 04 Special DIETHYLSTILBESTROL - POWDER (GM) 30 $712.80Tier 04 Special DIFFERIN 0.1% - CREAM (GRAMS) 45 $97.33Tier 04 Special DIFFERIN 0.1% - GEL (GM) 45 $98.80Tier 04 Special DIFFERIN 0.1% - SWAB, MEDICATED 60 $82.37Tier 04 Special DIFLUCAN 100MG - TABLET 30 $271.13Tier 03 Under $40 DIFLUCAN 10MG/ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 35 $36.96Tier 04 Special DIFLUCAN 150MG - TABLET 30 $431.64Tier 03 Under $40 DIFLUNISAL 500MG - TABLET 30 $27.82Tier 01 Under $10 DIGITEK 250MCG - TABLET 30 $5.14Tier 01 Under $10 DIGOXIN 125MCG - TABLET 30 $4.71Tier 01 Under $10 DIGOXIN 250MCG - TABLET 30 $5.00Tier 01 Under $10 DILANTIN 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $9.24Tier 03 Under $40 DILTIA XT 180MG - CAPSULE, DEGRADABLE CONTROLLED-RELEASE 30 $20.22Tier 03 Under $40 DILTIAZEM HCL 120MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $27.87Tier 02 Under $20 DILTIAZEM HCL 180MG - CAPSULE, DEGRADABLE CONTROLLED-RELEASE 30 $17.91Tier 03 Under $40 DILTIAZEM HCL 180MG - CAPSULE, SUSTAINED ACTION 30 $24.45Tier 03 Under $40 DILTIAZEM HCL 180MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $30.91Tier 03 Under $40 DILTIAZEM HCL 240MG - CAPSULE, DEGRADABLE CONTROLLED-RELEASE 30 $25.75Tier 03 Under $40 DILTIAZEM HCL 240MG - CAPSULE, SUSTAINED ACTION 30 $39.59Tier 04 Special DILTIAZEM HCL 240MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $43.34Tier 04 Special DILTIAZEM HCL 300MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $57.88Tier 01 Under $10 DILTIAZEM HCL 30MG - TABLET 30 $1.91Tier 03 Under $40 DILT-XR 180MG - CAPSULE, DEGRADABLE CONTROLLED-RELEASE 30 $20.22Tier 03 Under $40 DILT-XR 240MG - CAPSULE, DEGRADABLE CONTROLLED-RELEASE 30 $28.77Tier 04 Special DIOVAN 160MG - TABLET 30 $50.49Tier 04 Special DIOVAN 320MG - TABLET 30 $64.01Tier 04 Special DIOVAN 80MG - TABLET 30 $47.26

13

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special DIOVAN HCT 160-12.5MG - TABLET 30 $54.96Tier 04 Special DIOVAN HCT 160-25MG - TABLET 30 $62.57Tier 04 Special DIOVAN HCT 80-12.5MG - TABLET 30 $50.62Tier 01 Under $10 DIPHENOXYLATE W/ATROPINE 2.5-.025MG - TABLET 30 $7.00Tier 04 Special DIPROLENE 0.05% - LOTION (ML) 30 $46.99Tier 01 Under $10 DIPYRIDAMOLE 50MG - TABLET 30 $7.36Tier 03 Under $40 DISOPYRAMIDE PHOSPHATE 150MG - CAPSULE, SUSTAINED ACTION 30 $23.02Tier 04 Special DITROPAN XL 10MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $90.68Tier 04 Special DITROPAN XL 15MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $99.00Tier 04 Special DITROPAN XL 5MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $91.21Tier 01 Under $10 DMAX 15-8-4MG/5 - SYRUP 60 $3.17Tier 02 Under $20 DMAX 4-2-2MG/ML - DROPS 30 $16.63Tier 01 Under $10 D-METHORPHAN HB/PE/CPM LIQ 15-10-2/5 - SYRUP 50 $1.87Tier 03 Under $40 DOLGIC LQ 325-40-50 - ELIXIR 180 $20.59Tier 01 Under $10 DONATUSSIN 15-10-2/5 - SYRUP 120 $3.17Tier 01 Under $10 DONATUSSIN 20-2-1/ML - DROPS 30 $6.07Tier 01 Under $10 DONATUSSIN DC 50-7.5-2.5 - SYRUP 120 $4.22Tier 03 Under $40 DONNATAL 48.6MG - TABLET, SUSTAINED ACTION 30 $27.46Tier 04 Special DORYX 100MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $122.50Tier 04 Special DOSTINEX 0.5MG - TABLET 30 $1,015.34Tier 04 Special DOVONEX 0.005% - CREAM (GRAMS) 60 $121.44Tier 04 Special DOVONEX 0.005% - OINTMENT(GM) 60 $121.44Tier 01 Under $10 DOXAZOSIN MESYLATE 2MG - TABLET 30 $7.60Tier 01 Under $10 DOXAZOSIN MESYLATE 4MG - TABLET 30 $6.41Tier 01 Under $10 DOXAZOSIN MESYLATE 8MG - TABLET 30 $8.18Tier 01 Under $10 DOXEPIN HCL 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $6.05Tier 01 Under $10 DOXEPIN HCL 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.38Tier 01 Under $10 DOXEPIN HCL 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.38Tier 02 Under $20 DOXEPIN HCL 150MG - CAPSULE (HARD, SOFT, ETC.) 30 $14.30Tier 01 Under $10 DOXEPIN HCL 25MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.82Tier 01 Under $10 DOXEPIN HCL 50MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.11Tier 01 Under $10 DOXYCYCLINE HYCLATE 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.42Tier 01 Under $10 DOXYCYCLINE HYCLATE 100MG - TABLET 30 $4.42Tier 01 Under $10 DOXYCYCLINE HYCLATE 50MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.16Tier 04 Special DOXYCYCLINE MONOHYDRATE 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $48.56Tier 02 Under $20 DRIHIST SR 20-8-2.5MG - TABLET, SUSTAINED RELEASE 12HR 30 $15.71Tier 01 Under $10 DRITUSS HD 100-30-2.5 - ELIXIR 180 $9.03Tier 01 Under $10 DRYSOL DAB-O-MATIC 20% - SOLUTION, NON-ORAL 35 $6.16Tier 04 Special DUAC 1-5% - GEL (GM) 45 $109.78Tier 02 Under $20 DUET 29-1MG - TABLET 30 $11.42Tier 03 Under $40 DUET DHA 29-250-1MG - COMBINATION PACKAGE 60 $27.46Tier 04 Special DUONEB 2.5-0.5/3 - SOLUTION, NON-ORAL 90 $57.02Tier 03 Under $40 DURADEX 1200-20MG - TABLET, SUSTAINED RELEASE 12HR 30 $26.40Tier 01 Under $10 DURADRIN 65-325-100 - CAPSULE (HARD, SOFT, ETC.) 30 $5.67Tier 03 Under $40 DURAFLU 20-60-500 - TABLET 30 $20.33

14

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special DURAGESIC 100MCG/HR - PATCH, TRANSDERMAL 72 HOURS 10 $522.28Tier 04 Special DURAGESIC 25MCG/HR - PATCH, TRANSDERMAL 72 HOURS 10 $141.15Tier 04 Special DURAGESIC 50MCG/HR - PATCH, TRANSDERMAL 72 HOURS 10 $258.02Tier 04 Special DURAGESIC 75MCG/HR - PATCH, TRANSDERMAL 72 HOURS 10 $393.54Tier 03 Under $40 DURAHIST 60-8-1.25 - TABLET, SUSTAINED RELEASE 12HR 30 $20.06Tier 03 Under $40 DURAHIST PE 20-8-1.25 - TABLET, SUSTAINED RELEASE 12HR 30 $20.06Tier 03 Under $40 DURAPHEN DM 1200-20-40 - TABLET, SUSTAINED RELEASE 12HR 30 $29.04Tier 03 Under $40 DURAPHEN FORTE 1200-30-30 - TABLET, SUSTAINED RELEASE 12HR 30 $27.72Tier 03 Under $40 DURAPHEN II 800-25MG - TABLET, SUSTAINED RELEASE 12HR 30 $24.29Tier 03 Under $40 DURAPHEN II DM 800-20-20 - TABLET, SUSTAINED RELEASE 12HR 30 $27.72Tier 04 Special DURATUSS 900-25MG - TABLET, SUSTAINED RELEASE 12HR 30 $45.14Tier 03 Under $40 DURATUSS DM 225-25MG/5 - SOLUTION, ORAL 120 $25.34Tier 04 Special DURATUSS GP 1200-25MG - TABLET, SUSTAINED RELEASE 12HR 30 $49.63Tier 04 Special DURATUSS HD 225-10-2.5 - SOLUTION, ORAL 300 $63.36Tier 04 Special DURICEF 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $54.56Tier 04 Special DURICEF 500MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $72.60Tier 04 Special DYNACIN 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $176.62Tier 04 Special DYNACIRC CR 5MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $52.80Tier 01 Under $10 DYPHYLLINE GG 200-200MG - TABLET 30 $8.25Tier 03 Under $40 DYTAN-CS 30-10-25MG - TABLET 30 $35.64Tier 02 Under $20 DYTAN-CS 30-7.5-25 - SUSPENSION, ORAL (FINAL DOSE FORM) 50 $12.76Tier 02 Under $20 E.E.S. 200 200MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 200 $15.84Tier 01 Under $10 EAR-GESIC 0.25-5-5% - DROPS 15 $9.69Tier 03 Under $40 ECONAZOLE NITRATE 1% - CREAM (GRAMS) 30 $24.47Tier 04 Special EFFEXOR 37.5MG - TABLET 30 $49.63Tier 04 Special EFFEXOR 75MG - TABLET 30 $54.38Tier 04 Special EFFEXOR XR 150MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $97.94Tier 04 Special EFFEXOR XR 37.5MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $80.26Tier 04 Special EFFEXOR XR 75MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $90.02Tier 04 Special EFUDEX 5% - CREAM (GRAMS) 40 $151.14Tier 04 Special ELESTAT 0.05% - DROPS 5 $66.53Tier 04 Special ELIDEL 1% - CREAM (GRAMS) 30 $51.74Tier 04 Special ELMIRON 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $70.75Tier 03 Under $40 ELOCON 0.1% - CREAM (GRAMS) 15 $26.29Tier 03 Under $40 EMBELINE 0.05% - SOLUTION, NON-ORAL 50 $35.21Tier 02 Under $20 EMBELINE E 0.05% - CREAM (GRAMS) 15 $15.64Tier 04 Special EMEND 125MG-80MG - CAPSULE, DOSE PACK 30 $2,832.46Tier 04 Special EMLA 2.5-2.5% - CREAM (GRAMS) 30 $48.05Tier 04 Special EMTRIVA 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $279.31Tier 01 Under $10 ENALAPRIL MALEATE 10MG - TABLET 30 $2.89Tier 01 Under $10 ENALAPRIL MALEATE 2.5MG - TABLET 30 $6.32Tier 01 Under $10 ENALAPRIL MALEATE 20MG - TABLET 30 $6.82Tier 01 Under $10 ENALAPRIL MALEATE 5MG - TABLET 30 $6.07Tier 03 Under $40 ENALAPRIL MALEATE/HCTZ 10-25MG - TABLET 30 $21.43Tier 04 Special ENBREL 25MG - KIT 8 $1,265.30

15

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special ENBREL 50MG/ML - DISPOSABLE SYRINGE (ML) 8 $2,582.20Tier 04 Special ENDOCET 10-650MG - TABLET 30 $42.66Tier 01 Under $10 ENDOCET 5-325MG - TABLET 30 $4.33Tier 03 Under $40 ENDOCET 7.5-500MG - TABLET 30 $21.91Tier 04 Special ENGERIX-B 20MCG/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 1 $56.36Tier 03 Under $40 ENPRESSE 6-5-10 - TABLET 30 $20.63Tier 03 Under $40 ENTEX HC 100-7.5-5 - SYRUP 120 $22.18Tier 03 Under $40 ENTEX LA 400MG-30MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $38.81Tier 04 Special ENTOCORT EC 3MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $87.38Tier 04 Special EPIFOAM 1%-1% - FOAM (GM) 20 $45.06Tier 04 Special EPIPEN 0.3MG/0.3 - DISPOSABLE SYRINGE (EA) 1 $47.07Tier 04 Special EPIPEN JR. 0.15MG/0.3 - DISPOSABLE SYRINGE (EA) 2 $88.62Tier 04 Special EPIQUIN MICRO 4% - CREAM, SUSTAINED RELEASE (GM) 30 $74.98Tier 01 Under $10 EPITOL 200MG - TABLET 30 $4.52Tier 04 Special EPIVIR HBV 100MG - TABLET 30 $188.50Tier 03 Under $40 ERRIN 0.35MG - TABLET 30 $27.86Tier 04 Special ERTACZO 2% - CREAM (GRAMS) 30 $43.56Tier 01 Under $10 ERY-TAB 250MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $6.86Tier 02 Under $20 ERY-TAB 333MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $10.30Tier 01 Under $10 ERYTHROMYCIN 5MG/G - OINTMENT(GM) 4 $3.77Tier 02 Under $20 ERYTHROMYCIN BASE 2% - GEL (GM) 30 $17.42Tier 01 Under $10 ERYTHROMYCIN BASE 250MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $6.38Tier 01 Under $10 ERYTHROMYCIN ETHYLSUCCINATE 200MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 60 $2.64Tier 01 Under $10 ERYTHROMYCIN ETHYLSUCCINATE 400MG - TABLET 30 $6.34Tier 01 Under $10 ERYTHROMYCIN ETHYLSUCCINATE 400MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 80 $5.63Tier 01 Under $10 ERYTHROMYCIN W/SULFISOXAZOLE 200-600/5 - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $7.31Tier 02 Under $20 ESKALITH CR 450MG - TABLET, SUSTAINED ACTION 30 $17.69Tier 02 Under $20 ESTAZOLAM 2MG - TABLET 30 $18.51Tier 04 Special ESTRACE 0.01% - CREAM WITH APPLICATOR 43 $65.08Tier 03 Under $40 ESTRACE 0.5MG - TABLET 30 $23.76Tier 03 Under $40 ESTRACE 1MG - TABLET 30 $28.18Tier 03 Under $40 ESTRACE 2MG - TABLET 30 $31.42Tier 03 Under $40 ESTRADERM 0.05MG/24H - PATCH, TRANSDERMAL BIWEEKLY 8 $37.59Tier 04 Special ESTRADERM 0.1MG/24HR - PATCH, TRANSDERMAL BIWEEKLY 8 $40.34Tier 01 Under $10 ESTRADIOL 0.5MG - TABLET 30 $4.21Tier 01 Under $10 ESTRADIOL 1MG - TABLET 30 $7.38Tier 01 Under $10 ESTRADIOL 2MG - TABLET 30 $6.75Tier 04 Special ESTRATEST 2.5-1.25MG - TABLET 30 $63.46Tier 04 Special ESTRATEST H.S. 1.25-0.625 - TABLET 30 $51.90Tier 04 Special ESTRING 7.5MCG/24H - RING, VAGINAL 1 $104.17Tier 04 Special ESTRIOL - POWDER (GM) 30 $2,956.80Tier 01 Under $10 ESTROPIPATE 0.75MG - TABLET 30 $8.27Tier 02 Under $20 ESTROPIPATE 1.5MG - TABLET 30 $10.06Tier 04 Special ESTROSTEP FE 5-7-9-7 - TABLET 30 $40.37Tier 02 Under $20 ETODOLAC 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $18.90

16

Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 ETODOLAC 400MG - TABLET 30 $14.33Tier 02 Under $20 ETODOLAC 500MG - TABLET 30 $13.50Tier 04 Special EVISTA 60MG - TABLET 30 $79.46Tier 04 Special EVOCLIN 1% - FOAM (GM) 50 $77.00Tier 04 Special EVOXAC 30MG - CAPSULE (HARD, SOFT, ETC.) 30 $45.94Tier 03 Under $40 EXELDERM 1% - SOLUTION, NON-ORAL 30 $23.76Tier 04 Special EXELON 6MG - CAPSULE (HARD, SOFT, ETC.) 30 $76.03Tier 01 Under $10 EXTENDRYL JR 10-4-1.25 - CAPSULE, SUSTAINED ACTION 30 $9.50Tier 04 Special FACTIVE 320MG - TABLET 30 $516.38Tier 01 Under $10 FAMOTIDINE 20MG - TABLET 30 $4.64Tier 01 Under $10 FAMOTIDINE 40MG - TABLET 30 $8.87Tier 04 Special FAMVIR 125MG - TABLET 30 $109.82Tier 04 Special FAMVIR 250MG - TABLET 30 $122.76Tier 04 Special FAMVIR 500MG - TABLET 30 $246.58Tier 04 Special FAST TAKE - STRIP 100 $78.32Tier 04 Special FEMARA 2.5MG - TABLET 30 $233.38Tier 03 Under $40 FEMHRT 0.005-1MG - TABLET 30 $38.75Tier 04 Special FEMRING 0.05MG/24H - RING, VAGINAL 1 $100.80Tier 04 Special FEMRING 0.1MG/24HR - RING, VAGINAL 1 $107.40Tier 01 Under $10 FEOGEN - CAPSULE (HARD, SOFT, ETC.) 30 $5.02Tier 01 Under $10 FERREX 150 FORTE 150-.025-1 - CAPSULE (HARD, SOFT, ETC.) 30 $5.56Tier 04 Special FINACEA 15% - GEL (GM) 30 $49.28Tier 04 Special FIORICET W/CODEINE 30-325-50 - CAPSULE (HARD, SOFT, ETC.) 30 $65.47Tier 04 Special FLAGYL 250MG - TABLET 30 $70.22Tier 04 Special FLAGYL 500MG - TABLET 30 $125.66Tier 03 Under $40 FLECAINIDE ACETATE 100MG - TABLET 30 $32.09Tier 04 Special FLECAINIDE ACETATE 150MG - TABLET 30 $58.89Tier 03 Under $40 FLECAINIDE ACETATE 50MG - TABLET 30 $26.24Tier 03 Under $40 FLEXERIL 10MG - TABLET 30 $39.73Tier 03 Under $40 FLEXERIL 5MG - TABLET 30 $34.32Tier 04 Special FLOMAX 0.4MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $54.65Tier 04 Special FLONASE 50MCG - AEROSOL, SPRAY, (GM) 16 $64.91Tier 03 Under $40 FLORINEF ACETATE 0.1MG - TABLET 30 $24.92Tier 04 Special FLOVENT 110MCG - AEROSOL W/ADAPTER (GM) 13 $84.08Tier 04 Special FLOVENT 220MCG - AEROSOL W/ADAPTER (GM) 26 $261.52Tier 04 Special FLOVENT 44MCG - AEROSOL W/ADAPTER (GM) 13 $62.81Tier 04 Special FLOXIN 0.3% - DROPS 5 $42.65Tier 04 Special FLOXIN 400MG - TABLET 30 $186.38Tier 03 Under $40 FLUCONAZOLE 100MG - TABLET 30 $24.90Tier 03 Under $40 FLUCONAZOLE 150MG - TABLET 30 $37.23Tier 03 Under $40 FLUCONAZOLE 200MG - TABLET 30 $39.83Tier 01 Under $10 FLUOCINOLONE ACETONIDE 0.01% - SOLUTION, NON-ORAL 60 $5.95Tier 01 Under $10 FLUOCINONIDE 0.05% - CREAM (GRAMS) 30 $4.60Tier 01 Under $10 FLUOCINONIDE 0.05% - GEL (GM) 15 $9.22Tier 01 Under $10 FLUOCINONIDE 0.05% - OINTMENT(GM) 30 $9.92

17

Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 FLUOCINONIDE 0.05% - SOLUTION, NON-ORAL 60 $19.09Tier 03 Under $40 FLUOCINONIDE-E 0.05% - CREAM (GRAMS) 60 $21.29Tier 01 Under $10 FLUOR-A-DAY 1MG - TABLET, CHEWABLE 30 $0.80Tier 01 Under $10 FLUORIDE 1MG - TABLET, CHEWABLE 30 $0.80Tier 01 Under $10 FLUOXETINE HCL 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.08Tier 01 Under $10 FLUOXETINE HCL 10MG - TABLET 30 $4.23Tier 01 Under $10 FLUOXETINE HCL 20MG - CAPSULE (HARD, SOFT, ETC.) 30 $1.81Tier 01 Under $10 FLUOXETINE HCL 20MG - TABLET 30 $7.65Tier 03 Under $40 FLUOXETINE HCL 20MG/5ML - SOLUTION, ORAL 75 $37.83Tier 04 Special FLUOXETINE HCL 40MG - CAPSULE (HARD, SOFT, ETC.) 30 $45.76Tier 01 Under $10 FLURAZEPAM HCL 15MG - CAPSULE (HARD, SOFT, ETC.) 30 $3.13Tier 01 Under $10 FLURBIPROFEN 100MG - TABLET 30 $9.83Tier 04 Special FLUVOXAMINE MALEATE 100MG - TABLET 30 $53.15Tier 04 Special FLUVOXAMINE MALEATE 50MG - TABLET 30 $50.09Tier 03 Under $40 FML 0.1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $23.19Tier 02 Under $20 FML FORTE 0.25% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $18.83Tier 03 Under $40 FML S.O.P. 0.1% - OINTMENT(GM) 4 $34.18Tier 02 Under $20 FOCALIN 2.5MG - TABLET 30 $15.05Tier 01 Under $10 FOLIC ACID 1MG - TABLET 30 $0.65Tier 02 Under $20 FOLTX 1-2.5-25MG - TABLET 30 $10.82Tier 02 Under $20 FOLTX 2-2.5-25MG - TABLET 30 $14.52Tier 04 Special FORADIL 12MCG - CAPSULE, WITH INHALATION DEVICE 30 $43.56Tier 04 Special FORTAZ 1G - VIAL (SDV,MDV OR ADDITIVE) (EA) 6 $75.13Tier 04 Special FORTEO 750MCG/3ML - DISPOSABLE SYRINGE (ML) 3 $576.73Tier 04 Special FOSAMAX 35MG - TABLET 30 $519.90Tier 04 Special FOSAMAX 70MG - TABLET 30 $521.14Tier 01 Under $10 FREESTYLE LANCETS - EACH 100 $7.92Tier 04 Special FREESTYLE SYSTEM - KIT 1 $66.00Tier 04 Special FREESTYLE TEST STRIPS - STRIP 100 $80.58Tier 04 Special FROVA 2.5MG - TABLET 30 $496.06Tier 01 Under $10 FUROSEMIDE 20MG - TABLET 30 $1.08Tier 01 Under $10 FUROSEMIDE 40MG - TABLET 30 $1.48Tier 01 Under $10 FUROSEMIDE 80MG - TABLET 30 $3.94Tier 04 Special FUZEON 90MG - KIT 1 $1,940.52Tier 04 Special GABITRIL 2MG - TABLET 30 $48.05Tier 04 Special GABITRIL 4MG - TABLET 30 $47.45Tier 01 Under $10 GANI-TUSS NR 100-10MG/5 - LIQUID (ML) 180 $4.57Tier 02 Under $20 GEMFIBROZIL 600MG - TABLET 30 $11.07Tier 01 Under $10 GENTAK 0.3% - DROPS 5 $1.91Tier 02 Under $20 GENTAK 0.3% - OINTMENT(GM) 4 $13.33Tier 01 Under $10 GENTAMICIN SULFATE 0.3% - DROPS 5 $1.97Tier 04 Special GEODON 40MG - CAPSULE (HARD, SOFT, ETC.) 30 $133.85Tier 02 Under $20 GFN 1000/DM 60 1000-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $14.42Tier 02 Under $20 GFN 1200/DM 60 1200-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $19.94Tier 01 Under $10 GFN 600/PHENYLEPHRINE 20 600-20MG - TABLET, SUSTAINED RELEASE 12HR 30 $8.93

18

Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 GFN-DM-PSE 1200-60-60 - TABLET, SUSTAINED RELEASE 12HR 30 $20.36Tier 01 Under $10 GLIPIZIDE 10MG - TABLET 30 $3.49Tier 01 Under $10 GLIPIZIDE 5MG - TABLET 30 $1.73Tier 02 Under $20 GLIPIZIDE ER 10MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $14.23Tier 01 Under $10 GLIPIZIDE ER 5MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $7.20Tier 02 Under $20 GLIPIZIDE XL 10MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $14.23Tier 04 Special GLUCAGON EMERGENCY KIT 1MG - KIT 1 $76.34Tier 04 Special GLUCOPHAGE 1000MG - TABLET 30 $47.92Tier 03 Under $40 GLUCOPHAGE 500MG - TABLET 30 $23.50Tier 03 Under $40 GLUCOPHAGE XR 500MG - TABLET, SUSTAINED RELEASE 24HR 30 $23.85Tier 03 Under $40 GLUCOPHAGE XR 750MG - TABLET, SUSTAINED RELEASE 24HR 30 $36.17Tier 03 Under $40 GLUCOTROL XL 10MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $26.93Tier 02 Under $20 GLUCOTROL XL 5MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $13.29Tier 01 Under $10 GLYBURIDE 2.5MG - TABLET 30 $6.38Tier 01 Under $10 GLYBURIDE 5MG - TABLET 30 $7.54Tier 01 Under $10 GLYBURIDE MICRONIZED 3MG - TABLET 30 $6.45Tier 02 Under $20 GLYBURIDE MICRONIZED 6MG - TABLET 30 $13.01Tier 03 Under $40 GLYBURIDE-METFORMIN HCL 2.5-500MG - TABLET 30 $21.74Tier 02 Under $20 GLYBURIDE-METFORMIN HCL 5-500MG - TABLET 30 $19.06Tier 03 Under $40 G-P 1200-75MG - TABLET, SUSTAINED RELEASE 12HR 30 $20.11Tier 04 Special GRIFULVIN V 125MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 125 $44.00Tier 01 Under $10 GUAIFEN PSE 600-120MG - TABLET, SUSTAINED RELEASE 12HR 30 $3.43Tier 01 Under $10 GUAIFENESIN 600/PSE 120 600-120MG - TABLET, SUSTAINED RELEASE 12HR 30 $3.42Tier 02 Under $20 GUAIFENESIN DM 1000-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $13.25Tier 01 Under $10 GUAIFENESIN W/CODEINE 100-10MG/5 - LIQUID (ML) 30 $0.82Tier 02 Under $20 GUAIFENESIN W/PSEUDOEPHEDRINE 1200-120MG - TABLET, SUSTAINED RELEASE 12HR 30 $19.37Tier 01 Under $10 GUAIFENESIN W/PSEUDOEPHEDRINE 600-120MG - TABLET, SUSTAINED RELEASE 12HR 30 $3.45Tier 01 Under $10 GUAIFENESIN W/PSEUDOEPHEDRINE 600MG-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $2.44Tier 02 Under $20 GUAIFENESIN/CODEINE PHOSPHATE 300-10MG - TABLET 30 $10.07Tier 02 Under $20 GUAIFENESIN/D-METHORPHAN 1200-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $19.94Tier 01 Under $10 GUAIFENESIN/P-EPHED HCL 500-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $7.29Tier 01 Under $10 GUAIFENESIN/PHENYLEPHRINE 600-40MG - TABLET, SUSTAINED RELEASE 12HR 30 $8.94Tier 01 Under $10 GUAIFENEX DM 600-30MG - TABLET, SUSTAINED RELEASE 12HR 30 $6.31Tier 01 Under $10 GUAIFENEX PSE 600-120MG - TABLET, SUSTAINED RELEASE 12HR 30 $3.60Tier 01 Under $10 GUAIFENEX PSE 600MG-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $2.46Tier 02 Under $20 GUANFACINE HCL 1MG - TABLET 30 $15.06Tier 02 Under $20 GUANFACINE HCL 2MG - TABLET 30 $15.15Tier 03 Under $40 GYNAZOLE-1 2% - CREAM, SUSTAINED RELEASE (GM) 5 $36.78Tier 02 Under $20 GYNODIOL 1.5MG - TABLET 30 $13.73Tier 04 Special HALFLYTELY 5MGX4-210G - COMBINATION PACKAGE 1 $42.90Tier 01 Under $10 HALOPERIDOL 1MG - TABLET 30 $3.34Tier 01 Under $10 HALOPERIDOL 2MG - TABLET 30 $4.42Tier 04 Special HAVRIX 1440 U/ML - DISPOSABLE SYRINGE (ML) 1 $60.32Tier 04 Special HAVRIX 1440 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 1 $61.63Tier 01 Under $10 H-C TUSSIVE 5-2.5-2 - SYRUP 60 $2.39

19

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special HELIDAC - COMBINATION PACKAGE 56 $205.00Tier 01 Under $10 HEMATINIC PLUS 106-1MG - TABLET 30 $8.99Tier 01 Under $10 HEMOCYTE-F 106-1MG - TABLET 30 $7.39Tier 02 Under $20 HEMORRHOIDAL HC 25MG - SUPPOSITORY, RECTAL 30 $12.38Tier 04 Special HEPARIN SODIUM 20000 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 15 $63.49Tier 04 Special HEPSERA 10MG - TABLET 30 $500.81Tier 01 Under $10 HISTEX PD 4MG/5ML - LIQUID (ML) 60 $8.98Tier 01 Under $10 HISTINEX HC 5-2.5-2 - SYRUP 60 $1.99Tier 01 Under $10 HISTINEX PV 30-2.5-2/5 - SYRUP 40 $2.69Tier 01 Under $10 HISTUSSIN HC 5-2.5-2 - SYRUP 120 $4.32Tier 01 Under $10 HT-TUSS DM 200-20/5ML - ELIXIR 120 $6.12Tier 04 Special HUMALOG 100 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $64.39Tier 04 Special HUMALOG MIX 75/25 75-25 U/ML - DISPOSABLE SYRINGE (ML) 30 $254.50Tier 03 Under $40 HUMIBID DM 400-200-50 - CAPSULE, SUSTAINED RELEASE 12 HR 30 $28.78Tier 03 Under $40 HUMIBID L.A. 600-300MG - TABLET, SUSTAINED RELEASE 12HR 30 $25.87Tier 04 Special HUMIRA 40MG/0.8ML - KIT 2 $1,265.26Tier 03 Under $40 HUMULIN 70/30 70-30 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $28.16Tier 03 Under $40 HUMULIN N 100 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $28.16Tier 01 Under $10 HYDRALAZINE HCL 25MG - TABLET 30 $7.28Tier 01 Under $10 HYDROCHLOROTHIAZIDE 12.5MG - CAPSULE (HARD, SOFT, ETC.) 30 $9.61Tier 01 Under $10 HYDROCHLOROTHIAZIDE 25MG - TABLET 30 $1.24Tier 01 Under $10 HYDROCHLOROTHIAZIDE 50MG - TABLET 30 $2.07Tier 03 Under $40 HYDROCODONE BIT-IBUPROFEN 200-7.5MG - TABLET 30 $21.78Tier 02 Under $20 HYDROCODONE BT/HOMATROPINE MBR 5-1.5MG - TABLET 30 $14.76Tier 01 Under $10 HYDROCODONE COMPOUND 5-1.5MG/5 - SYRUP 120 $3.71Tier 01 Under $10 HYDROCODONE W/ACETAMINOPHEN 10-500MG - TABLET 30 $7.87Tier 01 Under $10 HYDROCODONE W/ACETAMINOPHEN 10-650MG - TABLET 30 $3.19Tier 02 Under $20 HYDROCODONE W/ACETAMINOPHEN 10-660MG - TABLET 30 $13.56Tier 01 Under $10 HYDROCODONE W/ACETAMINOPHEN 2.5-500MG - TABLET 30 $6.52Tier 01 Under $10 HYDROCODONE W/ACETAMINOPHEN 5-500MG - TABLET 30 $1.59Tier 01 Under $10 HYDROCODONE W/ACETAMINOPHEN 7.5-500MG - TABLET 30 $5.69Tier 01 Under $10 HYDROCODONE W/ACETAMINOPHEN 7.5-650MG - TABLET 30 $3.58Tier 01 Under $10 HYDROCODONE W/ACETAMINOPHEN 7.5-750MG - TABLET 30 $2.98Tier 01 Under $10 HYDROCODONE W/GUAIFENESIN 100-5/5ML - SYRUP 30 $0.63Tier 02 Under $20 HYDROCODONE/ACETAMINOPHEN 10-325MG - TABLET 30 $13.04Tier 01 Under $10 HYDROCODONE/ACETAMINOPHEN 10-500MG - TABLET 30 $9.99Tier 01 Under $10 HYDROCODONE/ACETAMINOPHEN 5-500MG - TABLET 30 $1.60Tier 02 Under $20 HYDROCODONE-ACETAMINOPHEN 10-325MG - TABLET 30 $14.18Tier 01 Under $10 HYDROCODONE-ACETAMINOPHEN 2.5-167/5 - SOLUTION, ORAL 50 $5.04Tier 01 Under $10 HYDROCODONE-ACETAMINOPHEN 5-500MG - TABLET 30 $1.60Tier 02 Under $20 HYDROCODONE-ACETAMINOPHEN 7.5-325MG - TABLET 30 $15.71Tier 01 Under $10 HYDROCODONE-ACETAMINOPHEN 7.5-500MG - TABLET 30 $5.70Tier 01 Under $10 HYDROCODONE-ACETAMINOPHEN 7.5-650MG - TABLET 30 $4.98Tier 01 Under $10 HYDROCODONE-ACETAMINOPHEN 7.5-750MG - TABLET 30 $4.17Tier 04 Special HYDROCORTISONE - POWDER (GM) 473 $1,689.93

20

Tier Tier Price Drug Name and Dosage Qty PriceTier 01 Under $10 HYDROCORTISONE 2.5% - CREAM (GRAMS) 20 $3.35Tier 03 Under $40 HYDROCORTISONE 2.5% - LOTION (ML) 59 $33.39Tier 01 Under $10 HYDROCORTISONE 2.5% - OINTMENT(GM) 30 $5.49Tier 01 Under $10 HYDROCORTISONE 20MG - TABLET 30 $2.78Tier 01 Under $10 HYDROCORTISONE ACETATE 25MG - SUPPOSITORY, RECTAL 10 $5.39Tier 02 Under $20 HYDROCORTISONE VALERATE 0.2% - CREAM (GRAMS) 15 $11.51Tier 02 Under $20 HYDROCORTISONE VALERATE 0.2% - OINTMENT(GM) 15 $10.17Tier 01 Under $10 HYDROMET 5-1.5MG/5 - SYRUP 60 $1.86Tier 01 Under $10 HYDROMORPHONE HCL 2MG - TABLET 30 $7.11Tier 01 Under $10 HYDROMORPHONE HCL 4MG - TABLET 30 $5.49Tier 03 Under $40 HYDRON KGS 300-5MG/5 - SYRUP 300 $21.87Tier 03 Under $40 HYDROQUINONE 3-5-4% - CREAM (GRAMS) 28 $31.70Tier 03 Under $40 HYDROQUINONE 4% - CREAM (GRAMS) 28 $31.34Tier 02 Under $20 HYDROXYCHLOROQUINE SULFATE 200MG - TABLET 30 $14.15Tier 03 Under $40 HYDROXYUREA 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $30.17Tier 01 Under $10 HYDROXYZINE HCL 10MG - TABLET 30 $7.95Tier 01 Under $10 HYDROXYZINE HCL 10MG/5ML - SYRUP 100 $1.71Tier 02 Under $20 HYDROXYZINE HCL 25MG - TABLET 30 $11.65Tier 01 Under $10 HYDROXYZINE HCL 50MG - TABLET 30 $9.92Tier 01 Under $10 HYDROXYZINE PAMOATE 25MG - CAPSULE (HARD, SOFT, ETC.) 30 $3.41Tier 01 Under $10 HYDROXYZINE PAMOATE 50MG - CAPSULE (HARD, SOFT, ETC.) 30 $3.51Tier 01 Under $10 HYOSCYAMINE SULFATE 0.125MG - TABLET 30 $1.57Tier 01 Under $10 HYOSCYAMINE SULFATE 0.125MG - TABLET, RAPID DISSOLVE 30 $1.89Tier 01 Under $10 HYOSCYAMINE SULFATE 0.125MG - TABLET, SUBLINGUAL 30 $1.88Tier 01 Under $10 HYOSCYAMINE SULFATE 0.125MG/ML - DROPS 15 $7.18Tier 01 Under $10 HYOSCYAMINE SULFATE 0.375MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $5.14Tier 04 Special HYZAAR 100-25MG - TABLET 30 $64.42Tier 04 Special HYZAAR 50-12.5MG - TABLET 30 $46.90Tier 01 Under $10 IBUPROFEN 600MG - TABLET 30 $1.30Tier 01 Under $10 IBUPROFEN 800MG - TABLET 30 $1.68Tier 01 Under $10 IMIPRAMINE HCL 10MG - TABLET 30 $7.80Tier 01 Under $10 IMIPRAMINE HCL 25MG - TABLET 30 $8.94Tier 02 Under $20 IMIPRAMINE HCL 50MG - TABLET 30 $12.77Tier 04 Special IMITREX 100MG - TABLET 30 $517.18Tier 04 Special IMITREX 20MG - SPRAY, NON-AEROSOL (EA) 6 $149.00Tier 04 Special IMITREX 25MG - TABLET 30 $556.51Tier 04 Special IMITREX 50MG - TABLET 30 $517.18Tier 04 Special IMITREX 6MG/0.5ML - KIT 1 $124.38Tier 04 Special IMITREX 6MG/0.5ML - KIT,REFILL 1 $117.81Tier 01 Under $10 INDAPAMIDE 1.25MG - TABLET 30 $2.46Tier 01 Under $10 INDAPAMIDE 2.5MG - TABLET 30 $4.04Tier 04 Special INDERAL LA 120MG - CAPSULE, SUSTAINED ACTION 24 HR 30 $52.27Tier 04 Special INDERAL LA 120MG - CAPSULE, SUSTAINED ACTION 24 HR 30 $52.27Tier 04 Special INDERAL LA 160MG - CAPSULE, SUSTAINED ACTION 24 HR 30 $68.38Tier 03 Under $40 INDERAL LA 60MG - CAPSULE, SUSTAINED ACTION 24 HR 30 $36.17

21

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special INDERAL LA 80MG - CAPSULE, SUSTAINED ACTION 24 HR 30 $42.24Tier 01 Under $10 INDOMETHACIN 25MG - CAPSULE (HARD, SOFT, ETC.) 30 $1.77Tier 01 Under $10 INDOMETHACIN 50MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.57Tier 03 Under $40 INDOMETHACIN 75MG - CAPSULE, SUSTAINED ACTION 30 $25.92Tier 03 Under $40 INNOPRAN XL 80MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $36.17Tier 01 Under $10 INSULIN SYRINGE 28GX0.5" - SYRINGE, EMPTY DISPOSABLE 30 $6.60Tier 02 Under $20 INSULIN SYRINGE 29 GAUGE - SYRINGE, EMPTY DISPOSABLE 100 $15.84Tier 01 Under $10 INSULIN SYRINGE 29GX7/16" - SYRINGE, EMPTY DISPOSABLE 60 $9.50Tier 03 Under $40 INSULIN SYRINGE 30GX0.5" - SYRINGE, EMPTY DISPOSABLE 100 $23.76Tier 03 Under $40 INSULIN SYRINGE 31GX0.312" - SYRINGE, EMPTY DISPOSABLE 100 $23.76Tier 04 Special INVIRASE 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $66.00Tier 01 Under $10 IOPHEN-C NR 100-10MG/5 - LIQUID (ML) 180 $4.57Tier 03 Under $40 IPRATROPIUM BROMIDE 0.2MG/ML - SOLUTION, NON-ORAL 125 $39.49Tier 03 Under $40 IPRATROPIUM BROMIDE 42MCG - AEROSOL, SPRAY (ML) 15 $35.11Tier 01 Under $10 ISOMETH/D-CHLORALPHENAZ/APAP 65-325-100 - CAPSULE (HARD, SOFT, ETC.) 30 $5.46Tier 01 Under $10 ISONIAZID 300MG - TABLET 30 $3.30Tier 03 Under $40 ISOSORBIDE MONONITRATE 120MG - TABLET, SUSTAINED RELEASE 24HR 30 $28.34Tier 01 Under $10 ISOSORBIDE MONONITRATE 30MG - TABLET, SUSTAINED RELEASE 24HR 30 $9.28Tier 02 Under $20 ISOSORBIDE MONONITRATE 60MG - TABLET, SUSTAINED RELEASE 24HR 30 $11.35Tier 01 Under $10 JANTOVEN 5MG - TABLET 30 $7.33Tier 01 Under $10 JANTOVEN 5MG - TABLET 30 $7.92Tier 04 Special KADIAN 20MG - CAPSULE, 24HR SUSTAINED RELEASE PELLETS 30 $64.42Tier 04 Special KADIAN 60MG - CAPSULE, 24HR SUSTAINED RELEASE PELLETS 30 $133.06Tier 04 Special KALETRA 33.3-133.3 - CAPSULE (HARD, SOFT, ETC.) 30 $103.22Tier 02 Under $20 K-DUR 20MEQ - TABLET, SUST.RELEASE,PARTICLES/CRYSTALS 30 $17.95Tier 03 Under $40 KENALOG - AEROSOL (GM) 63 $30.49Tier 04 Special KEPPRA 500MG - TABLET 30 $65.91Tier 04 Special KERALAC 50% - CREAM (GRAMS) 255 $87.52Tier 04 Special KETEK 400MG - TABLET 30 $152.33Tier 04 Special KETEK PAK 400MG - TABLET 30 $152.33Tier 02 Under $20 KETOCONAZOLE 2% - CREAM (GRAMS) 15 $11.23Tier 03 Under $40 KETOCONAZOLE 200MG - TABLET 30 $38.74Tier 01 Under $10 KETOPROFEN 75MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.41Tier 02 Under $20 KETOROLAC TROMETHAMINE 10MG - TABLET 30 $11.34Tier 01 Under $10 KETOROLAC TROMETHAMINE 60MG/2ML - CARTRIDGE (ML) 4 $7.74Tier 03 Under $40 KETOROLAC TROMETHAMINE 60MG/2ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 20 $39.60Tier 01 Under $10 KETOSTIX REAGENT - STRIP 50 $8.80Tier 04 Special KLARON 10% - LOTION (ML) 118 $96.57Tier 03 Under $40 KLONOPIN 0.5MG - TABLET 30 $31.15Tier 01 Under $10 KLOR-CON 10 10MEQ - TABLET, SUSTAINED ACTION 30 $3.67Tier 02 Under $20 KLOR-CON 20MEQ - PACKET 90 $15.00Tier 01 Under $10 KLOR-CON 8 8MEQ - TABLET, SUSTAINED ACTION 30 $2.91Tier 01 Under $10 KLOR-CON M20 20MEQ - TABLET, SUST.RELEASE,PARTICLES/CRYSTALS 30 $9.79Tier 01 Under $10 KLOR-CON/EF 25MEQ - TABLET, EFFERVESCENT 30 $6.87Tier 03 Under $40 KRISTALOSE 10G - PACKET 30 $27.72

22

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special KRISTALOSE 20G - PACKET 30 $43.03Tier 04 Special KYTRIL 1MG - TABLET 30 $1,242.12Tier 04 Special KYTRIL 1MG - TABLET 30 $1,242.12Tier 01 Under $10 LABETALOL HCL 100MG - TABLET 30 $6.68Tier 02 Under $20 LABETALOL HCL 200MG - TABLET 30 $10.58Tier 02 Under $20 LABETALOL HCL 300MG - TABLET 30 $16.54Tier 02 Under $20 LAC-HYDRIN 12% - CREAM (GRAMS) 140 $19.71Tier 04 Special LAMICTAL 100MG - TABLET 30 $100.58Tier 04 Special LAMICTAL 150MG - TABLET 30 $105.86Tier 04 Special LAMICTAL 200MG - TABLET 30 $110.88Tier 04 Special LAMICTAL 25MG - TABLET 30 $94.78Tier 04 Special LAMICTAL 25MG - TABLET 30 $94.78Tier 04 Special LAMICTAL 25MG - TABLET 30 $94.78Tier 04 Special LAMISIL 250MG - TABLET 30 $284.59Tier 01 Under $10 LANCETS - EACH 100 $4.75Tier 01 Under $10 LANOXIN 125MCG - TABLET 30 $6.60Tier 01 Under $10 LANOXIN 250MCG - TABLET 30 $6.60Tier 04 Special LANTUS 100 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $60.57Tier 01 Under $10 LASIX 20MG - TABLET 30 $6.07Tier 04 Special LESCOL XL 80MG - TABLET, SUSTAINED RELEASE 24HR 30 $73.14Tier 03 Under $40 LESSINA 0.1-0.02 - TABLET 30 $22.66Tier 04 Special LEUCOVORIN CALCIUM 5MG - TABLET 30 $58.58Tier 03 Under $40 LEVALL G 400MG-90MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $31.68Tier 03 Under $40 LEVALL-12 30-30MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 118 $28.04Tier 04 Special LEVAQUIN 250MG - TABLET 30 $255.29Tier 04 Special LEVAQUIN 500MG - TABLET 30 $292.78Tier 04 Special LEVAQUIN 750MG - TABLET 30 $570.81Tier 04 Special LEVITRA 10MG - TABLET 30 $280.10Tier 04 Special LEVITRA 20MG - TABLET 30 $280.10Tier 04 Special LEVITRA 5MG - TABLET 30 $280.10Tier 03 Under $40 LEVLITE-28 0.1-0.02 - TABLET 30 $36.70Tier 01 Under $10 LEVOBUNOLOL HCL 0.5% - DROPS 5 $5.64Tier 01 Under $10 LEVOTHROID 25MCG - TABLET 30 $5.38Tier 01 Under $10 LEVOTHYROXINE SODIUM 100MCG - TABLET 30 $7.81Tier 01 Under $10 LEVOTHYROXINE SODIUM 112MCG - TABLET 30 $8.10Tier 01 Under $10 LEVOTHYROXINE SODIUM 125MCG - TABLET 30 $8.37Tier 01 Under $10 LEVOTHYROXINE SODIUM 150MCG - TABLET 30 $8.52Tier 02 Under $20 LEVOTHYROXINE SODIUM 175MCG - TABLET 30 $10.59Tier 02 Under $20 LEVOTHYROXINE SODIUM 200MCG - TABLET 30 $11.25Tier 01 Under $10 LEVOTHYROXINE SODIUM 25MCG - TABLET 30 $5.73Tier 01 Under $10 LEVOTHYROXINE SODIUM 50MCG - TABLET 30 $6.21Tier 01 Under $10 LEVOXYL 100MCG - TABLET 30 $8.02Tier 01 Under $10 LEVOXYL 112MCG - TABLET 30 $7.97Tier 01 Under $10 LEVOXYL 125MCG - TABLET 30 $8.40Tier 01 Under $10 LEVOXYL 150MCG - TABLET 30 $8.91

23

Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 LEVOXYL 175MCG - TABLET 30 $10.80Tier 01 Under $10 LEVOXYL 25MCG - TABLET 30 $5.69Tier 01 Under $10 LEVOXYL 50MCG - TABLET 30 $6.21Tier 01 Under $10 LEVOXYL 75MCG - TABLET 30 $9.11Tier 01 Under $10 LEVOXYL 88MCG - TABLET 30 $9.52Tier 04 Special LEXAPRO 10MG - TABLET 30 $64.15Tier 04 Special LEXAPRO 20MG - TABLET 30 $66.79Tier 04 Special LEXAPRO 5MG - TABLET 30 $61.25Tier 04 Special LIBRAX 5-2.5MG - CAPSULE (HARD, SOFT, ETC.) 30 $66.00Tier 01 Under $10 LIDOCAINE HCL 40MG/ML - SOLUTION, NON-ORAL 50 $7.54Tier 02 Under $20 LIDOCAINE HCL 5% - OINTMENT(GM) 35 $12.02Tier 01 Under $10 LIDOCAINE HCL VISCOUS 20MG/ML - SOLUTION, NON-ORAL 30 $0.76Tier 03 Under $40 LIDODERM 5%(700MG) - ADHESIVE PATCH, MEDICATED 6 $31.52Tier 04 Special LIPITOR 10MG - TABLET 30 $71.19Tier 04 Special LIPITOR 20MG - TABLET 30 $103.34Tier 04 Special LIPITOR 40MG - TABLET 30 $103.18Tier 04 Special LIPITOR 80MG - TABLET 30 $104.02Tier 01 Under $10 LISINOPRIL 10MG - TABLET 30 $5.54Tier 01 Under $10 LISINOPRIL 2.5MG - TABLET 30 $4.13Tier 01 Under $10 LISINOPRIL 20MG - TABLET 30 $9.46Tier 02 Under $20 LISINOPRIL 40MG - TABLET 30 $10.31Tier 01 Under $10 LISINOPRIL 5MG - TABLET 30 $5.03Tier 01 Under $10 LISINOPRIL-HCTZ 10-12.5MG - TABLET 30 $8.75Tier 02 Under $20 LISINOPRIL-HCTZ 20-12.5MG - TABLET 30 $12.69Tier 02 Under $20 LISINOPRIL-HCTZ 20-25MG - TABLET 30 $14.11Tier 01 Under $10 LITHIUM CARBONATE 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $1.94Tier 01 Under $10 LITHIUM CARBONATE 300MG - TABLET 30 $4.92Tier 01 Under $10 LITHIUM CARBONATE 300MG - TABLET, SUSTAINED ACTION 30 $9.57Tier 02 Under $20 LITHIUM CARBONATE 450MG - TABLET, SUSTAINED ACTION 30 $11.38Tier 02 Under $20 LITHOBID 300MG - TABLET, SUSTAINED ACTION 30 $15.05Tier 03 Under $40 LO/OVRAL-28 0.3-0.03MG - TABLET 30 $36.96Tier 04 Special LOCOID 0.1% - CREAM (GRAMS) 30 $46.93Tier 04 Special LOCOID 0.1% - OINTMENT(GM) 30 $43.03Tier 02 Under $20 LODRANE 6MG - TABLET, SUSTAINED RELEASE 12HR 30 $11.35Tier 04 Special LOESTRIN 1-0.02MG - TABLET 30 $59.49Tier 04 Special LOESTRIN FE 1.5-0.03MG - TABLET 30 $43.90Tier 04 Special LOESTRIN FE 1-0.02MG - TABLET 30 $43.30Tier 01 Under $10 LOPERAMIDE HCL 2MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.64Tier 03 Under $40 LOPRESSOR HCT 50MG-25MG - TABLET 30 $35.90Tier 04 Special LOPROX 0.77% - CREAM (GRAMS) 30 $54.91Tier 04 Special LOPROX 0.77% - GEL (GM) 45 $77.62Tier 04 Special LOPROX 1% - SHAMPOO 120 $59.14Tier 01 Under $10 LORAZEPAM 0.5MG - TABLET 30 $6.68Tier 01 Under $10 LORAZEPAM 1MG - TABLET 30 $2.58Tier 01 Under $10 LORAZEPAM 2MG - TABLET 30 $5.55

24

Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 LORTUSS HC 7.5-3.75/5 - LIQUID (ML) 180 $17.42Tier 03 Under $40 LOTEMAX 0.5% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $31.11Tier 03 Under $40 LOTENSIN 10MG - TABLET 30 $33.26Tier 03 Under $40 LOTENSIN 5MG - TABLET 30 $33.26Tier 04 Special LOTREL 10-20MG - CAPSULE (HARD, SOFT, ETC.) 30 $79.00Tier 04 Special LOTREL 5-10MG - CAPSULE (HARD, SOFT, ETC.) 30 $64.21Tier 04 Special LOTREL 5-20MG - CAPSULE (HARD, SOFT, ETC.) 30 $67.72Tier 04 Special LOTRISONE 1-0.05% - LOTION (ML) 30 $55.70Tier 03 Under $40 LOVASTATIN 10MG - TABLET 30 $23.14Tier 03 Under $40 LOVASTATIN 20MG - TABLET 30 $25.72Tier 03 Under $40 LOVASTATIN 40MG - TABLET 30 $33.98Tier 04 Special LOVENOX 100MG/ML - DISPOSABLE SYRINGE (ML) 14 $916.98Tier 04 Special LOVENOX 120MG/.8ML - DISPOSABLE SYRINGE (ML) 13 $1,222.48Tier 04 Special LOVENOX 30MG/0.3ML - DISPOSABLE SYRINGE (ML) 6 $392.46Tier 04 Special LOVENOX 40MG/0.4ML - DISPOSABLE SYRINGE (ML) 4 $261.71Tier 03 Under $40 LOW-OGESTREL 0.3-0.03MG - TABLET 30 $23.03Tier 04 Special LUMIGAN 0.03% - DROPS 3 $70.17Tier 04 Special LUPRON 1MG/0.2ML - KIT 1 $433.51Tier 04 Special LUPRON DEPOT 3.75MG - KIT 1 $522.13Tier 01 Under $10 LURIDE 0.25MG - TABLET, CHEWABLE 30 $1.58Tier 04 Special LUXIQ 0.12% - FOAM (GM) 100 $118.80Tier 04 Special MALARONE 250-100MG - TABLET 30 $135.96Tier 03 Under $40 MAVIK 1MG - TABLET 30 $31.68Tier 03 Under $40 MAVIK 2MG - TABLET 30 $31.68Tier 03 Under $40 MAVIK 4MG - TABLET 30 $31.68Tier 01 Under $10 MAX HC 8-5-4MG/5 - LIQUID (ML) 120 $7.39Tier 04 Special MAXAIR AUTOHALER 0.2MG - AEROSOL, BREATH ACTIVATED 14 $80.70Tier 04 Special MAXALT 10MG - TABLET 30 $505.03Tier 04 Special MAXALT MLT 10MG - TABLET, RAPID DISSOLVE 30 $507.76Tier 02 Under $20 MAXIFED 700-80MG - TABLET, SUSTAINED RELEASE 12HR 30 $19.27Tier 03 Under $40 MAXIFED DM 580-30-60 - TABLET, SUSTAINED RELEASE 12HR 30 $21.12Tier 03 Under $40 MAXIFED DMX 700-40-80 - TABLET, SUSTAINED RELEASE 12HR 30 $20.33Tier 02 Under $20 MAXIFED-G 580-60MG - TABLET 30 $18.22Tier 03 Under $40 MAXZIDE 75-50MG - TABLET 30 $39.86Tier 04 Special MEBENDAZOLE 100MG - TABLET, CHEWABLE 30 $121.58Tier 01 Under $10 MECLIZINE HCL 12.5MG - TABLET 30 $2.18Tier 01 Under $10 MECLIZINE HCL 25MG - TABLET 30 $2.36Tier 04 Special MEDROL 16MG - TABLET 30 $70.75Tier 04 Special MEDROL 32MG - TABLET 30 $100.32Tier 03 Under $40 MEDROL 4MG - TABLET, DOSE PACK 30 $32.74Tier 01 Under $10 MEDROXYPROGESTERONE ACETATE 10MG - TABLET 30 $6.34Tier 01 Under $10 MEDROXYPROGESTERONE ACETATE 2.5MG - TABLET 30 $5.72Tier 01 Under $10 MEDROXYPROGESTERONE ACETATE 5MG - TABLET 30 $9.60Tier 02 Under $20 MEGESTROL ACETATE 20MG - TABLET 30 $11.43Tier 02 Under $20 MEGESTROL ACETATE 40MG - TABLET 30 $17.47

25

Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 MENEST 0.625MG - TABLET 30 $18.48Tier 03 Under $40 MENEST 1.25MG - TABLET 30 $25.61Tier 04 Special MENTAX 1% - CREAM (GRAMS) 30 $71.02Tier 02 Under $20 MEPERIDINE HCL 50MG - TABLET 30 $15.44Tier 02 Under $20 MEPERIDINE W/PROMETHAZINE 50MG-25MG - CAPSULE (HARD, SOFT, ETC.) 30 $15.66Tier 04 Special MEPRON 750MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 210 $702.85Tier 02 Under $20 MEPROZINE 50MG-25MG - CAPSULE (HARD, SOFT, ETC.) 30 $15.54Tier 03 Under $40 MESCOLOR 120-8-2.5 - TABLET, SUSTAINED RELEASE 12HR 30 $22.44Tier 04 Special METADATE CD 10MG - CAPSULE, MULTIPHASIC RELEASE 30-70 30 $60.72Tier 04 Special METADATE CD 20MG - CAPSULE, MULTIPHASIC RELEASE 30-70 30 $60.72Tier 04 Special METADATE CD 30MG - CAPSULE, MULTIPHASIC RELEASE 30-70 30 $60.72Tier 03 Under $40 METADATE ER 20MG - TABLET, SUSTAINED ACTION 30 $27.72Tier 03 Under $40 METAGLIP 2.5-250MG - TABLET 30 $24.29Tier 03 Under $40 METAGLIP 2.5-500MG - TABLET 30 $29.04Tier 02 Under $20 METFORMIN HCL 1000MG - TABLET 30 $10.33Tier 01 Under $10 METFORMIN HCL 500MG - TABLET 30 $6.52Tier 01 Under $10 METFORMIN HCL 850MG - TABLET 30 $7.78Tier 02 Under $20 METFORMIN HCL ER 500MG - TABLET, SUSTAINED RELEASE 24HR 30 $14.10Tier 01 Under $10 METHADONE HCL 5MG - TABLET 30 $1.86Tier 03 Under $40 METHERGINE 0.2MG - TABLET 30 $24.82Tier 02 Under $20 METHIMAZOLE 10MG - TABLET 30 $14.71Tier 02 Under $20 METHIMAZOLE 5MG - TABLET 30 $10.93Tier 01 Under $10 METHOCARBAMOL 500MG - TABLET 30 $7.22Tier 01 Under $10 METHOCARBAMOL 750MG - TABLET 30 $4.19Tier 03 Under $40 METHOTREXATE 2.5MG - TABLET 30 $27.09Tier 01 Under $10 METHYLDOPA 250MG - TABLET 30 $4.64Tier 01 Under $10 METHYLDOPA 500MG - TABLET 30 $7.11Tier 02 Under $20 METHYLIN 20MG - TABLET 30 $16.07Tier 01 Under $10 METHYLIN 5MG - TABLET 30 $6.91Tier 02 Under $20 METHYLPHENIDATE HCL 10MG - TABLET 30 $12.21Tier 02 Under $20 METHYLPHENIDATE HCL 20MG - TABLET 30 $15.40Tier 01 Under $10 METHYLPHENIDATE HCL 5MG - TABLET 30 $7.12Tier 01 Under $10 METHYLPREDNISOLONE 4MG - TABLET 30 $6.51Tier 02 Under $20 METHYLPREDNISOLONE 4MG - TABLET, DOSE PACK 30 $10.97Tier 01 Under $10 METOCLOPRAMIDE HCL 10MG - TABLET 30 $3.88Tier 01 Under $10 METOCLOPRAMIDE HCL 5MG - TABLET 30 $4.97Tier 01 Under $10 METOCLOPRAMIDE HCL 5MG/5ML - SOLUTION, ORAL 60 $1.27Tier 03 Under $40 METOLAZONE 5MG - TABLET 30 $35.49Tier 01 Under $10 METOPROLOL TARTRATE 100MG - TABLET 30 $3.48Tier 01 Under $10 METOPROLOL TARTRATE 25MG - TABLET 30 $5.82Tier 01 Under $10 METOPROLOL TARTRATE 50MG - TABLET 30 $1.52Tier 04 Special METROCREAM 0.75% - CREAM (GRAMS) 45 $82.37Tier 04 Special METROGEL 0.75% - GEL (GM) 45 $68.31Tier 04 Special METROGEL-VAGINAL 0.75% - GEL WITH APPLICATOR (GM) 70 $57.90Tier 04 Special METROLOTION 0.75% - LOTION (ML) 59 $82.55

26

Tier Tier Price Drug Name and Dosage Qty PriceTier 01 Under $10 METRONIDAZOLE 250MG - TABLET 30 $3.36Tier 01 Under $10 METRONIDAZOLE 500MG - TABLET 30 $4.96Tier 02 Under $20 MEXILETINE HCL 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $15.63Tier 02 Under $20 MEXILETINE HCL 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $16.70Tier 04 Special MIACALCIN 200 U/DOSE - AEROSOL, SPRAY W/PUMP (ML) 4 $90.82Tier 04 Special MICARDIS 40MG - TABLET 30 $46.73Tier 04 Special MICARDIS 80MG - TABLET 30 $50.16Tier 04 Special MICARDIS HCT 40-12.5MG - TABLET 30 $50.16Tier 04 Special MICARDIS HCT 80-12.5MG - TABLET 30 $53.59Tier 04 Special MICARDIS HCT 80-25MG - TABLET 30 $60.72Tier 01 Under $10 MICROCHAMBER - INHALER (EA) 1 $9.24Tier 02 Under $20 MICRO-K 10 10MEQ - CAPSULE, SUSTAINED ACTION 30 $10.30Tier 01 Under $10 MICROLET - EACH 100 $8.80Tier 01 Under $10 MIGQUIN 65-325-100 - CAPSULE (HARD, SOFT, ETC.) 30 $5.51Tier 01 Under $10 MIGRAZONE 65-325-100 - CAPSULE (HARD, SOFT, ETC.) 30 $5.73Tier 01 Under $10 MIGRIN-A 65-325-100 - CAPSULE (HARD, SOFT, ETC.) 30 $5.49Tier 04 Special MINOCIN 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $105.86Tier 03 Under $40 MINOCYCLINE HCL 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $37.30Tier 03 Under $40 MINOCYCLINE HCL 50MG - CAPSULE (HARD, SOFT, ETC.) 30 $23.46Tier 04 Special MINOCYCLINE HCL 75MG - CAPSULE (HARD, SOFT, ETC.) 30 $47.03Tier 02 Under $20 MINOXIDIL 10MG - TABLET 30 $18.34Tier 03 Under $40 MINTAB C 1200-60-60 - TABLET, SUSTAINED RELEASE 12HR 30 $22.14Tier 03 Under $40 MIRALAX 100% - POWDER (GM) 255 $20.20Tier 03 Under $40 MIRAPEX 0.125MG - TABLET 30 $31.59Tier 03 Under $40 MIRAPEX 0.25MG - TABLET 30 $36.17Tier 04 Special MIRAPEX 0.5MG - TABLET 30 $65.38Tier 01 Under $10 MIRAPHEN PSE 600-120MG - TABLET, SUSTAINED RELEASE 12HR 30 $3.71Tier 03 Under $40 MIRCETTE 21-5 - TABLET 30 $36.96Tier 03 Under $40 MIRTAZAPINE 15MG - TABLET 30 $37.18Tier 03 Under $40 MIRTAZAPINE 30MG - TABLET 30 $25.33Tier 04 Special MIRTAZAPINE 30MG - TABLET, RAPID DISSOLVE 30 $52.44Tier 04 Special MOBIC 15MG - TABLET 30 $117.92Tier 04 Special MOBIC 7.5MG - TABLET 30 $84.68Tier 03 Under $40 MOMETASONE FUROATE 0.1% - OINTMENT(GM) 15 $20.41Tier 01 Under $10 MORPHINE SULFATE 15MG - TABLET 30 $3.88Tier 03 Under $40 MORPHINE SULFATE 30MG - TABLET, SUSTAINED ACTION 30 $36.53Tier 01 Under $10 MORPHINE SULFATE IR 15MG - TABLET 30 $3.88Tier 02 Under $20 MOTRIN 800MG - TABLET 30 $13.73Tier 01 Under $10 MUCINEX DM 600-30MG - TABLET, SUSTAINED RELEASE 12HR 30 $9.35Tier 01 Under $10 MULTI-RET FOLIC 500 105-0.8MG - TABLET, SUSTAINED ACTION 30 $9.07Tier 01 Under $10 MULTIVITAMINS W/FLUORIDE 0.5MG - TABLET, CHEWABLE 30 $2.62Tier 01 Under $10 MULTIVITAMINS W/FLUORIDE 1MG - TABLET, CHEWABLE 30 $2.62Tier 04 Special MYSOLINE 250MG - TABLET 30 $52.01Tier 02 Under $20 MYSOLINE 50MG - TABLET 30 $14.43Tier 01 Under $10 MYTUSSIN AC 100-10MG/5 - SYRUP 25 $0.49

27

Tier Tier Price Drug Name and Dosage Qty PriceTier 01 Under $10 MYTUSSIN DAC 100-30-10 - SYRUP 120 $3.17Tier 03 Under $40 NABUMETONE 500MG - TABLET 30 $20.93Tier 03 Under $40 NABUMETONE 750MG - TABLET 30 $33.03Tier 03 Under $40 NADOLOL 120MG - TABLET 30 $30.67Tier 02 Under $20 NADOLOL 20MG - TABLET 30 $12.59Tier 02 Under $20 NADOLOL 40MG - TABLET 30 $13.62Tier 02 Under $20 NADOLOL 80MG - TABLET 30 $17.87Tier 03 Under $40 NAFTIN 1% - CREAM (GRAMS) 30 $39.47Tier 03 Under $40 NAFTIN 1% - GEL (GM) 30 $39.86Tier 04 Special NAMENDA 10MG - TABLET 30 $63.69Tier 04 Special NAMENDA 5MG - TABLET 30 $61.51Tier 01 Under $10 NAPROXEN 250MG - TABLET 30 $3.71Tier 01 Under $10 NAPROXEN 375MG - TABLET 30 $5.27Tier 01 Under $10 NAPROXEN 500MG - TABLET 30 $4.82Tier 02 Under $20 NAPROXEN 500MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $17.07Tier 01 Under $10 NAPROXEN SODIUM 550MG - TABLET 30 $8.20Tier 04 Special NASACORT AQ 55MCG - AEROSOL, SPRAY, (GM) 17 $70.43Tier 04 Special NASAREL 29MCG - AEROSOL, SPRAY (ML) 25 $49.72Tier 04 Special NASONEX 50MCG - SPRAY, NON-AEROSOL (GM) 17 $68.22Tier 02 Under $20 NATAFORT 60-1MG - TABLET 30 $12.94Tier 01 Under $10 NATALCARE 90-1MG - TABLET 30 $5.12Tier 01 Under $10 NATALCARE PLUS 27-1MG - TABLET 30 $3.85Tier 01 Under $10 NATATAB 29-1MG - TABLET 30 $7.13Tier 02 Under $20 NATELLE 27-1MG - TABLET 30 $10.82Tier 02 Under $20 NATELLE-EZ 25-1MG - TABLET 30 $11.35Tier 03 Under $40 NECON 1-0.035MG - TABLET 30 $22.25Tier 03 Under $40 NECON 7 DAYS X 3 - TABLET 30 $23.34Tier 03 Under $40 NEFAZODONE HCL 100MG - TABLET 30 $21.18Tier 02 Under $20 NEFAZODONE HCL 150MG - TABLET 30 $16.64Tier 02 Under $20 NEFAZODONE HCL 200MG - TABLET 30 $18.65Tier 02 Under $20 NEFAZODONE HCL 200MG - TABLET 30 $19.43Tier 01 Under $10 NEOMYCIN/POLYMYXIN/DEXAMETH 0.1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $4.88Tier 03 Under $40 NEOMYCIN/POLYMYXIN/HC 3.5-10K-1 - SOLUTION, NON-ORAL 10 $20.38Tier 04 Special NEURONTIN 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $40.92Tier 04 Special NEURONTIN 400MG - CAPSULE (HARD, SOFT, ETC.) 30 $48.31Tier 04 Special NEURONTIN 600MG - TABLET 30 $77.88Tier 04 Special NEXIUM 20MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $130.68Tier 04 Special NEXIUM 40MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $130.68Tier 04 Special NEXIUM 40MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $130.68Tier 04 Special NIASPAN 1000MG - TABLET, SUSTAINED ACTION 30 $68.40Tier 03 Under $40 NIASPAN 500MG - TABLET, SUSTAINED ACTION 30 $38.02Tier 04 Special NIASPAN 750MG - TABLET, SUSTAINED ACTION 30 $57.64Tier 03 Under $40 NIFEDICAL XL 30MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $26.35Tier 04 Special NIFEDICAL XL 60MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $51.95Tier 03 Under $40 NIFEDIPINE ER 30MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $26.35

28

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special NIFEDIPINE ER 60MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $48.00Tier 04 Special NIFEDIPINE ER 90MG - TABLET, SUST. RELEASE OSMOTIC PUSH 30 $55.24Tier 02 Under $20 NIFEREX-150 FORTE 150-25-1 - CAPSULE (HARD, SOFT, ETC.) 30 $14.78Tier 01 Under $10 NITRO-BID 2% - OINTMENT(GM) 16 $4.22Tier 03 Under $40 NITROFURANTOIN MACROCRYSTAL 50MG - CAPSULE (HARD, SOFT, ETC.) 30 $23.12Tier 03 Under $40 NITROFURANTOIN MONOHYD MACRO 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $34.32Tier 03 Under $40 NITROGLYCERIN 0.2MG/HR - PATCH, TRANSDERMAL 24 HOURS 30 $25.62Tier 03 Under $40 NITROGLYCERIN 0.4MG/HR - PATCH, TRANSDERMAL 24 HOURS 30 $34.72Tier 03 Under $40 NITROGLYCERIN TRANSDERMAL 0.1MG/HR - PATCH, TRANSDERMAL 24 HOURS 30 $30.79Tier 01 Under $10 NITROQUICK 0.4MG - TABLET, SUBLINGUAL 30 $2.57Tier 01 Under $10 NITROTAB 0.4MG - TABLET, SUBLINGUAL 30 $2.64Tier 04 Special NIZATIDINE 150MG - CAPSULE (HARD, SOFT, ETC.) 30 $49.96Tier 03 Under $40 NIZORAL 2% - SHAMPOO 120 $27.46Tier 03 Under $40 NORDETTE-28 0.15-0.03 - TABLET 30 $37.84Tier 03 Under $40 NOREL SR 40-325-8MG - TABLET, SUSTAINED RELEASE 12HR 30 $22.44Tier 04 Special NORITATE 1% - CREAM (GRAMS) 60 $87.65Tier 03 Under $40 NORTREL 1-0.035MG - TABLET 30 $22.25Tier 03 Under $40 NORTREL 7 DAYS X 3 - TABLET 30 $23.34Tier 01 Under $10 NORTRIPTYLINE HCL 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.99Tier 01 Under $10 NORTRIPTYLINE HCL 25MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.34Tier 01 Under $10 NORTRIPTYLINE HCL 50MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.91Tier 01 Under $10 NORTRIPTYLINE HCL 75MG - CAPSULE (HARD, SOFT, ETC.) 30 $6.68Tier 04 Special NORVASC 10MG - TABLET 30 $62.22Tier 04 Special NORVASC 2.5MG - TABLET 30 $45.25Tier 04 Special NORVASC 5MG - TABLET 30 $43.56Tier 02 Under $20 NOVANATAL 29-1MG - TABLET 30 $12.14Tier 03 Under $40 NOVOFINE 30 30GX0.8" - NEEDLE, DISPOSABLE 100 $27.28Tier 03 Under $40 NOVOFINE 31 31GX0.6" - NEEDLE, DISPOSABLE 100 $29.04Tier 03 Under $40 NOVOLIN 70/30 70-30 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $28.16Tier 04 Special NOVOLIN N 100 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 20 $56.32Tier 04 Special NOVOLIN R 100 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 20 $56.32Tier 04 Special NOVOLOG 100 U/ML - CARTRIDGE (ML) 30 $236.94Tier 04 Special NOVOLOG 100 U/ML - DISPOSABLE SYRINGE (ML) 15 $127.25Tier 04 Special NOVOLOG 100 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $64.99Tier 04 Special NOVOLOG MIX 70/30 70-30 U/ML - DISPOSABLE SYRINGE (ML) 15 $127.25Tier 04 Special NOVOLOG MIX 70/30 70-30 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $65.91Tier 03 Under $40 NUBAIN 10MG/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $23.58Tier 03 Under $40 NULEV 0.125MG - TABLET, RAPID DISSOLVE 30 $21.65Tier 03 Under $40 NULEV 0.125MG - TABLET, RAPID DISSOLVE 30 $21.65Tier 03 Under $40 NUVARING 0.12-0.015 - RING, VAGINAL 1 $36.50Tier 01 Under $10 NYSTATIN 100000 U/G - CREAM (GRAMS) 15 $1.45Tier 01 Under $10 NYSTATIN 100000 U/G - OINTMENT(GM) 30 $3.21Tier 04 Special NYSTATIN 500MMU - POWDER (GM) 120 $250.27Tier 01 Under $10 NYSTATIN W/TRIAMCINOLONE 100000-0.1 - CREAM (GRAMS) 15 $1.78Tier 03 Under $40 OFLOXACIN 0.3% - DROPS 5 $33.49

29

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special OFLOXACIN 200MG - TABLET 30 $110.80Tier 04 Special OLUX 0.05% - FOAM (GM) 100 $176.00Tier 04 Special OMEPRAZOLE 10MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $93.75Tier 04 Special OMEPRAZOLE 20MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $75.52Tier 04 Special OMNICEF 125MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 60 $42.60Tier 04 Special OMNICEF 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 60 $83.17Tier 04 Special OMNICEF 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $125.66Tier 01 Under $10 ONE TOUCH LANCETS - EACH 100 $7.92Tier 04 Special ONE TOUCH ULTRA SYSTEM - KIT 1 $60.50Tier 04 Special ONE TOUCH ULTRA TEST STRIPS - STRIP 100 $81.84Tier 04 Special OPTIVAR 0.05% - DROPS 6 $68.75Tier 02 Under $20 ORAPRED 15MG/5ML - SOLUTION, ORAL 25 $12.54Tier 03 Under $40 ORPHENADRINE CITRATE 100MG - TABLET, SUSTAINED ACTION 30 $38.99Tier 02 Under $20 ORTHO EVRA 20-150/24H - PATCH, TRANSDERMAL WEEKLY 1 $12.59Tier 04 Special ORTHO MICRONOR 0.35MG - TABLET 30 $53.17Tier 04 Special ORTHO TRI-CYCLEN 7 DAYS X 3 - TABLET 30 $41.18Tier 04 Special ORTHO TRI-CYCLEN LO 7DAYSX3 LO - TABLET 30 $40.39Tier 04 Special ORTHO-CEPT 0.15-0.03 - TABLET 30 $46.68Tier 04 Special ORTHO-CYCLEN 0.25-0.035 - TABLET 30 $45.06Tier 04 Special ORTHO-NOVUM 1-0.035MG - TABLET 30 $45.83Tier 04 Special ORTHO-NOVUM 7 DAYS X 3 - TABLET 30 $44.26Tier 04 Special OVACE 10% - CREAM (GRAMS) 60 $86.06Tier 04 Special OVACE 10% - LIQUID (ML) 340 $83.78Tier 04 Special OVCON-35 0.4-0.035 - TABLET 30 $40.36Tier 03 Under $40 OVCON-35 0.4-0.035 - TABLET, CHEWABLE 30 $36.70Tier 02 Under $20 OXAPROZIN 600MG - TABLET 30 $10.01Tier 02 Under $20 OXAZEPAM 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $10.68Tier 02 Under $20 OXAZEPAM 15MG - CAPSULE (HARD, SOFT, ETC.) 30 $15.38Tier 03 Under $40 OXISTAT 1% - CREAM (GRAMS) 30 $38.81Tier 04 Special OXSORALEN 1% - LOTION (ML) 60 $370.13Tier 04 Special OXSORALEN-ULTRA 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $342.41Tier 01 Under $10 OXYBUTYNIN CHLORIDE 5MG - TABLET 30 $2.90Tier 01 Under $10 OXYCODONE HCL 5MG - CAPSULE (HARD, SOFT, ETC.) 30 $6.65Tier 01 Under $10 OXYCODONE HCL 5MG - TABLET 30 $5.13Tier 04 Special OXYCODONE HYDROCHLORIDE - POWDER (GM) 2 $94.41Tier 01 Under $10 OXYCODONE W/ACETAMINOPHEN 5-325MG - TABLET 30 $4.66Tier 01 Under $10 OXYCODONE W/ACETAMINOPHEN 5-500MG - CAPSULE (HARD, SOFT, ETC.) 30 $7.05Tier 04 Special OXYCONTIN 10MG - TABLET, SUSTAINED RELEASE 12HR 30 $43.03Tier 04 Special OXYCONTIN 20MG - TABLET, SUSTAINED RELEASE 12HR 30 $82.37Tier 04 Special OXYCONTIN 40MG - TABLET, SUSTAINED RELEASE 12HR 30 $146.26Tier 04 Special OXYCONTIN 80MG - TABLET, SUSTAINED RELEASE 12HR 30 $274.82Tier 02 Under $20 OXYIR 5MG - CAPSULE (HARD, SOFT, ETC.) 30 $10.30Tier 04 Special OXYTROL 3.9MG/24HR - PATCH, TRANSDERMAL BIWEEKLY 8 $84.97Tier 01 Under $10 PANCOF PD 7.5-3-2/5 - SYRUP 60 $8.98Tier 04 Special PANDEL 0.1% - CREAM (GRAMS) 30 $48.84

30

Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 PANLOR SS 32-713-60 - TABLET 30 $31.42Tier 02 Under $20 PANMIST DM 595-32-48 - TABLET, SUSTAINED RELEASE 12HR 30 $15.58Tier 02 Under $20 PANMIST JR 595MG-48MG - TABLET, SUSTAINED RELEASE 12HR 30 $11.09Tier 04 Special PAREGORIC 2MG/5ML - LIQUID (ML) 400 $88.64Tier 03 Under $40 PAROMOMYCIN SULFATE 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $26.54Tier 04 Special PAROXETINE HCL 10MG - TABLET 30 $58.06Tier 04 Special PAROXETINE HCL 20MG - TABLET 30 $57.12Tier 03 Under $40 PAROXETINE HCL 30MG - TABLET 30 $36.04Tier 04 Special PAROXETINE HCL 40MG - TABLET 30 $56.05Tier 04 Special PATANOL 0.1% - DROPS 5 $69.83Tier 04 Special PAXIL 10MG - TABLET 30 $80.78Tier 04 Special PAXIL 20MG - TABLET 30 $84.22Tier 04 Special PAXIL 40MG - TABLET 30 $91.61Tier 04 Special PAXIL CR 12.5MG - TABLET, SUSTAINED RELEASE 24HR 30 $79.20Tier 04 Special PAXIL CR 25MG - TABLET, SUSTAINED RELEASE 24HR 30 $82.63Tier 04 Special PAXIL CR 37.5MG - TABLET, SUSTAINED RELEASE 24HR 30 $85.27Tier 04 Special PCE 333MG - TABLET, PARTICLES/CRYSTALS IN 30 $52.27Tier 04 Special PEGASYS 180MCG/0.5 - KIT 1 $1,482.23Tier 03 Under $40 PEMOLINE 37.5MG - TABLET 30 $21.27Tier 03 Under $40 PEN NEEDLE 31 GAUGE - NEEDLE, DISPOSABLE 100 $27.28Tier 03 Under $40 PEN NEEDLE 31GX0.312" - NEEDLE, DISPOSABLE 100 $26.40Tier 01 Under $10 PENICILLIN V POTASSIUM 250MG - TABLET 30 $2.51Tier 01 Under $10 PENICILLIN V POTASSIUM 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 200 $4.59Tier 01 Under $10 PENICILLIN V POTASSIUM 500MG - TABLET 30 $4.41Tier 04 Special PENLAC 8% - SOLUTION, NON-ORAL 7 $133.67Tier 02 Under $20 PENTASA 250MG - CAPSULE, SUSTAINED ACTION 30 $19.54Tier 03 Under $40 PENTAZOCINE AND NALOXONE HCL 50-0.5MG - TABLET 30 $28.04Tier 01 Under $10 PENTOXIFYLLINE 400MG - TABLET, SUSTAINED ACTION 30 $8.99Tier 04 Special PEPCID 40MG - TABLET 30 $103.49Tier 02 Under $20 P-EPD TAN/CHLOR-TAN 75-4.5/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 120 $19.92Tier 02 Under $20 P-EPHEDRINE-GUAFENESIN LA 795MG-85MG - TABLET, SUSTAINED RELEASE 12HR 30 $13.20Tier 03 Under $40 PERCOCET 2.5-325MG - TABLET 30 $31.15Tier 04 Special PERCOCET 7.5-325MG - TABLET 30 $46.99Tier 01 Under $10 PERIOGARD 1.2MG/ML - LIQUID (ML) 473 $6.84Tier 03 Under $40 PERIOSTAT 20MG - TABLET 30 $35.11Tier 03 Under $40 PHENADOZ 25MG - SUPPOSITORY, RECTAL 30 $29.84Tier 01 Under $10 PHENAVENT D 1200-40MG - TABLET, SUSTAINED RELEASE 12HR 30 $9.63Tier 01 Under $10 PHENAZOPYRIDINE HCL 100MG - TABLET 30 $3.14Tier 01 Under $10 PHENAZOPYRIDINE HCL 200MG - TABLET 30 $5.48Tier 02 Under $20 PHENERGAN 25MG - TABLET 30 $15.58Tier 01 Under $10 PHENOBARBITAL 20MG/5ML - ELIXIR 600 $7.91Tier 01 Under $10 PHENOBARBITAL 64.8MG - TABLET 30 $1.13Tier 01 Under $10 PHENOBARBITAL 97.2MG - TABLET 30 $1.68Tier 03 Under $40 PHENYL CHLOR-TAN 5-4.5MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 120 $26.91Tier 03 Under $40 PHENYTEK 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $26.14

31

Tier Tier Price Drug Name and Dosage Qty PriceTier 01 Under $10 PHOS-FLUR 1.1% - GEL (GM) 51 $8.08Tier 01 Under $10 PHOS-FLUR 1.1% - GEL (GM) 56 $8.87Tier 01 Under $10 PIROXICAM 20MG - CAPSULE (HARD, SOFT, ETC.) 30 $3.34Tier 04 Special PLAN B 0.75MG - TABLET 30 $363.00Tier 04 Special PLAQUENIL 200MG - TABLET 30 $49.90Tier 04 Special PLAVIX 75MG - TABLET 30 $122.95Tier 03 Under $40 PLENDIL 5MG - TABLET, SUSTAINED RELEASE 24HR 30 $36.96Tier 04 Special PLETAL 100MG - TABLET 30 $53.59Tier 04 Special PLEXION 10-5%(W/W) - CLEANSER (GM) 340 $95.74Tier 04 Special PLEXION SCT 10-5%(W/W) - CREAM (GRAMS) 113 $60.23Tier 01 Under $10 PNEUMOTUSSIN 200-2.5/5 - SYRUP 120 $9.50Tier 02 Under $20 PNEUMOTUSSIN 300-2.5MG - TABLET 30 $11.35Tier 03 Under $40 POLYCITRA 500-550/5 - SYRUP 473 $33.30Tier 01 Under $10 POLY-IRON 150 FORTE 150-.025-1 - CAPSULE (HARD, SOFT, ETC.) 30 $5.54Tier 02 Under $20 POLYMYXIN B SUL/TRIMETHOPRIM 10K U-0.1% - DROPS 10 $12.50Tier 02 Under $20 POLYTRIM 10K U-0.1% - DROPS 5 $15.22Tier 01 Under $10 POLYVITAMINS W/FLUORIDE 0.25MG/ML - DROPS 50 $4.01Tier 04 Special PONSTEL 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $60.19Tier 01 Under $10 POTASSIUM CHLORIDE 10MEQ - CAPSULE, SUSTAINED ACTION 30 $5.48Tier 01 Under $10 POTASSIUM CHLORIDE 20MEQ - TABLET, SUST.RELEASE,PARTICLES/CRYSTALS 30 $9.44Tier 02 Under $20 POTASSIUM CHLORIDE 25MEQ - TABLET, EFFERVESCENT 30 $14.80Tier 01 Under $10 POTASSIUM CHLORIDE 8MEQ - TABLET, SUSTAINED ACTION 30 $2.91Tier 04 Special PRAMOSONE 1%-1% - CREAM (GRAMS) 57 $49.16Tier 04 Special PRAMOSONE 2.5%-1% - LOTION (ML) 120 $80.26Tier 04 Special PRAVACHOL 20MG - TABLET 30 $91.30Tier 04 Special PRAVACHOL 40MG - TABLET 30 $133.82Tier 04 Special PRAVACHOL 80MG - TABLET 30 $135.17Tier 01 Under $10 PRAZOSIN HCL 1MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.97Tier 02 Under $20 PRAZOSIN HCL 5MG - CAPSULE (HARD, SOFT, ETC.) 30 $13.02Tier 02 Under $20 PRECARE 40-1MG - TABLET, CHEWABLE 30 $15.05Tier 02 Under $20 PRECARE CONCEIVE 30-1MG - TABLET 30 $11.62Tier 02 Under $20 PRECARE PRENATAL 40-1MG - TABLET 30 $13.98Tier 04 Special PRECISION Q-I-D - STRIP 100 $76.56Tier 03 Under $40 PRECOSE 25MG - TABLET 30 $21.12Tier 03 Under $40 PRECOSE 50MG - TABLET 30 $22.70Tier 03 Under $40 PRED FORTE 1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $21.82Tier 03 Under $40 PRED MILD 0.12% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $21.82Tier 01 Under $10 PREDNISOLONE 15MG/5ML - SYRUP 25 $5.34Tier 01 Under $10 PREDNISOLONE ACETATE 1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $8.79Tier 01 Under $10 PREDNISONE 10MG - TABLET 30 $1.84Tier 01 Under $10 PREDNISONE 10MG - TABLET, DOSE PACK 30 $6.07Tier 01 Under $10 PREDNISONE 20MG - TABLET 30 $3.08Tier 01 Under $10 PREDNISONE 5MG - TABLET 30 $0.91Tier 01 Under $10 PREDNISONE 5MG - TABLET, DOSE PACK 30 $4.00Tier 03 Under $40 PREFEST 1-1-0.09MG - TABLET 30 $39.07

32

Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 PREMARIN 0.3MG - TABLET 30 $29.50Tier 03 Under $40 PREMARIN 0.45MG - TABLET 30 $30.62Tier 03 Under $40 PREMARIN 0.625MG - TABLET 30 $30.28Tier 04 Special PREMARIN 0.625MG/G - CREAM WITH APPLICATOR 43 $67.73Tier 03 Under $40 PREMARIN 0.9MG - TABLET 30 $35.38Tier 03 Under $40 PREMARIN 1.25MG - TABLET 30 $35.38Tier 02 Under $20 PREMESIS RX 1MG - TABLET, MULTIPHASIC RELEASE 30 $13.73Tier 04 Special PREMPHASE 0.625-5MG - TABLET, SEQUENTIAL 30 $40.88Tier 04 Special PREMPRO 0.3-1.5MG - TABLET 30 $40.88Tier 04 Special PREMPRO 0.45-1.5MG - TABLET 30 $41.12Tier 04 Special PREMPRO 0.625-2.5 - TABLET 30 $41.12Tier 01 Under $10 PRENATAL MR 90 FE 90-1MG - TABLET, SUSTAINED ACTION 30 $5.76Tier 01 Under $10 PRENATAL MTR 27-1MG - TABLET 30 $5.69Tier 01 Under $10 PRENATAL PLUS 27-1MG - TABLET 30 $3.86Tier 01 Under $10 PRENATAL RX 1 60-1MG - TABLET 30 $5.47Tier 01 Under $10 PRENATAL RX 27-0.5MG - TABLET 30 $1.56Tier 02 Under $20 PRENATE ELITE 90-50-1MG - TABLET 30 $18.22Tier 04 Special PRESTIGE SMART SYSTEM - STRIP 100 $40.48Tier 04 Special PREVACID 15MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $128.57Tier 04 Special PREVACID 30MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $130.94Tier 04 Special PREVACID NAPRAPAC 15MG-500MG - COMBINATION PACKAGE 84 $119.75Tier 01 Under $10 PREVIDENT 0.2% - SOLUTION, NON-ORAL 473 $8.32Tier 01 Under $10 PREVIDENT 1.1% - GEL (ML) 106 $8.40Tier 01 Under $10 PREVIDENT 5000 PLUS 1.1% - CREAM (GRAMS) 51 $7.99Tier 04 Special PREVPAC 30-500-500 - COMBINATION PACKAGE 14 $278.19Tier 04 Special PRILOSEC 40MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $174.77Tier 02 Under $20 PRILOSEC OTC 20MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $16.63Tier 03 Under $40 PRIMACARE 30-1MG - COMBINATION PACKAGE 60 $21.65Tier 03 Under $40 PRIMACARE ONE 27-300-1MG - CAPSULE (HARD, SOFT, ETC.) 30 $22.70Tier 02 Under $20 PRIMIDONE 250MG - TABLET 30 $19.27Tier 02 Under $20 PROBENECID 500MG - TABLET 30 $18.62Tier 01 Under $10 PROCHLORPERAZINE 10MG - TABLET 30 $4.36Tier 02 Under $20 PROCHLORPERAZINE 5MG - TABLET 30 $12.71Tier 01 Under $10 PROCHLORPERAZINE MALEATE 10MG - TABLET 30 $7.38Tier 02 Under $20 PROCHLORPERAZINE MALEATE 5MG - TABLET 30 $12.71Tier 01 Under $10 PRO-COF 300-5MG/5 - SYRUP 120 $8.11Tier 04 Special PROCRIT 10000 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 15 $1,968.52Tier 04 Special PROCTOFOAM-HC 1%-1% - FOAM (GM) 10 $45.85Tier 02 Under $20 PROCTOSOL-HC 2.5% - CREAM (GRAMS) 28 $11.16Tier 02 Under $20 PROCTOZONE-HC 2.5% - CREAM (GRAMS) 30 $18.98Tier 03 Under $40 PROGESTERONE - POWDER (GM) 20 $29.57Tier 03 Under $40 PROGESTERONE IN OIL 50MG/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 10 $34.14Tier 04 Special PROGRAF 0.5MG - CAPSULE (HARD, SOFT, ETC.) 30 $59.93Tier 04 Special PROGRAF 1MG - CAPSULE (HARD, SOFT, ETC.) 30 $106.13Tier 04 Special PROGRAF 5MG - CAPSULE (HARD, SOFT, ETC.) 30 $542.78

33

Tier Tier Price Drug Name and Dosage Qty PriceTier 01 Under $10 PROMETHAZINE HCL 12.5MG - TABLET 30 $7.92Tier 01 Under $10 PROMETHAZINE HCL 12.5MG - TABLET 30 $7.92Tier 01 Under $10 PROMETHAZINE HCL 25MG - SUPPOSITORY, RECTAL 5 $7.82Tier 01 Under $10 PROMETHAZINE HCL 25MG - TABLET 30 $5.88Tier 01 Under $10 PROMETHAZINE HCL 6.25MG/5ML - SYRUP 60 $1.91Tier 02 Under $20 PROMETHAZINE VC W/CODEINE 5-10-6.25 - SYRUP 120 $10.20Tier 01 Under $10 PROMETHAZINE W/CODEINE 10-6.25/5 - SYRUP 90 $2.52Tier 01 Under $10 PROMETHAZINE W/DM 15-6.25/5 - SYRUP 70 $1.21Tier 01 Under $10 PROMETHEGAN 25MG - SUPPOSITORY, RECTAL 3 $4.69Tier 03 Under $40 PROMETRIUM 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $32.47Tier 03 Under $40 PROPAFENONE HCL 150MG - TABLET 30 $31.83Tier 04 Special PROPAFENONE HCL 225MG - TABLET 30 $41.55Tier 01 Under $10 PROPOXYPHENE HCL W/APAP 65-650MG - TABLET 30 $3.22Tier 01 Under $10 PROPOXYPHENE NAPSYLATE W/APAP 100-650MG - TABLET 30 $5.70Tier 02 Under $20 PROPOXYPHENE NAPSYLATE W/APAP 50-325MG - TABLET 30 $10.02Tier 01 Under $10 PROPRANOLOL HCL 10MG - TABLET 30 $1.78Tier 01 Under $10 PROPRANOLOL HCL 20MG - TABLET 30 $2.10Tier 01 Under $10 PROPRANOLOL HCL 40MG - TABLET 30 $2.50Tier 01 Under $10 PROPRANOLOL HCL 60MG - TABLET 30 $5.94Tier 01 Under $10 PROPRANOLOL HCL 80MG - TABLET 30 $2.15Tier 01 Under $10 PROPRANOLOL HCL W/HCTZ 40-25MG - TABLET 30 $2.82Tier 01 Under $10 PROPRANOLOL HCL W/HCTZ 80-25MG - TABLET 30 $3.92Tier 01 Under $10 PROPYLTHIOURACIL 50MG - TABLET 30 $3.15Tier 04 Special PROSCAR 5MG - TABLET 30 $83.09Tier 03 Under $40 PROSED EC 81.6-0.06 - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $36.96Tier 03 Under $40 PROSED/DS 81.6-0.06 - TABLET 30 $33.26Tier 04 Special PROSOM 2MG - TABLET 30 $41.71Tier 04 Special PROTONIX 20MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $104.28Tier 04 Special PROTONIX 40MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $104.28Tier 04 Special PROTOPIC 0.03% - OINTMENT(GM) 30 $58.08Tier 04 Special PROTOPIC 0.1% - OINTMENT(GM) 30 $62.30Tier 04 Special PROVENTIL HFA 90MCG - AEROSOL W/ADAPTER (GM) 7 $40.41Tier 03 Under $40 PROVERA 10MG - TABLET 30 $39.34Tier 04 Special PROVIGIL 200MG - TABLET 30 $182.69Tier 04 Special PROZAC 20MG - CAPSULE (HARD, SOFT, ETC.) 30 $116.95Tier 04 Special PROZAC WEEKLY 90MG - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 4 $87.47Tier 01 Under $10 PSEUDO DM GG 100-15-40 - SYRUP 180 $9.80Tier 01 Under $10 PSEUDOEPHEDRINE W/CHLORPHENIR 120-8MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $3.11Tier 01 Under $10 PSEUDOVENT PED 300-60MG - CAPSULE, SUSTAINED ACTION 30 $4.86Tier 04 Special PULMICORT 0.25MG/2ML - AMPUL FOR NEBULIZATION (ML) 60 $133.06Tier 04 Special PULMICORT 0.5MG/2ML - AMPUL FOR NEBULIZATION (ML) 60 $139.92Tier 04 Special PULMICORT 200MCG - AEROSOL POWDER, BREATH ACTIVATED 1 $144.97Tier 04 Special PULMOZYME 1MG/ML - SOLUTION, NON-ORAL 75 $1,409.76Tier 03 Under $40 PYRIDIUM PLUS 150-0.3-15 - TABLET 30 $38.28Tier 01 Under $10 Q-BID DM 600-30MG - TABLET, SUSTAINED RELEASE 12HR 30 $9.35

34

Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 QDALL 100MG-12MG - CAPSULE, SUSTAINED RELEASE 24 HR 30 $24.55Tier 01 Under $10 QUAL-TUSSIN 20-2-1/ML - DROPS 30 $7.64Tier 03 Under $40 QUINARETIC 10-12.5MG - TABLET 30 $28.07Tier 03 Under $40 QUINARETIC 20-25MG - TABLET 30 $28.07Tier 02 Under $20 QUININE SULFATE 325MG - CAPSULE (HARD, SOFT, ETC.) 30 $10.94Tier 04 Special QUIXIN 0.5% - DROPS 5 $42.46Tier 04 Special QVAR 40MCG - AEROSOL W/ADAPTER (GM) 7 $47.99Tier 04 Special QVAR 80MCG - AEROSOL W/ADAPTER (GM) 7 $60.49Tier 01 Under $10 RANITIDINE HCL 150MG - CAPSULE (HARD, SOFT, ETC.) 30 $4.65Tier 01 Under $10 RANITIDINE HCL 150MG - TABLET 30 $4.06Tier 01 Under $10 RANITIDINE HCL 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $6.72Tier 01 Under $10 RANITIDINE HCL 300MG - TABLET 30 $6.67Tier 04 Special RELION N 100 U/ML - VIAL (SDV,MDV OR ADDITIVE) (ML) 30 $73.66Tier 04 Special RELPAX 20MG - TABLET 30 $473.09Tier 04 Special RELPAX 40MG - TABLET 30 $466.49Tier 04 Special REMERON 30MG - TABLET 30 $89.50Tier 03 Under $40 RENAGEL 800MG - TABLET 30 $39.07Tier 04 Special REQUIP 0.25MG - TABLET 30 $41.18Tier 04 Special REQUIP 4MG - TABLET 30 $66.26Tier 02 Under $20 RESPA-DM 600-28MG - TABLET, SUSTAINED RELEASE 12HR 30 $12.94Tier 03 Under $40 RESPI-TANN 25-75MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 120 $38.02Tier 04 Special RESTASIS 0.05% - DROPPERETTE, SINGLE-USE DROP DISPENSER 32 $88.17Tier 04 Special RESTORIL 7.5MG - CAPSULE (HARD, SOFT, ETC.) 30 $68.90Tier 04 Special RETIN-A MICRO 0.04% - GEL (GM) 20 $47.17Tier 04 Special RETROVIR 300MG - TABLET 30 $170.54Tier 04 Special REYATAZ 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $385.44Tier 04 Special RHINOCORT AQUA 32MCG - SPRAY, NON-AEROSOL (GM) 9 $73.02Tier 04 Special RIBASPHERE 200MG - CAPSULE (HARD, SOFT, ETC.) 30 $214.11Tier 04 Special RISPERDAL 0.25MG - TABLET 30 $88.44Tier 04 Special RISPERDAL 0.5MG - TABLET 30 $96.89Tier 04 Special RISPERDAL 1MG - TABLET 30 $102.96Tier 04 Special RISPERDAL 2MG - TABLET 30 $161.30Tier 04 Special RISPERDAL 2MG - TABLET, RAPID DISSOLVE 30 $190.61Tier 04 Special RISPERDAL CONSTA 37.5MG/2ML - DISPOSABLE SYRINGE (EA) 2 $751.22Tier 03 Under $40 RITALIN 10MG - TABLET 30 $21.91Tier 02 Under $20 RITALIN 5MG - TABLET 30 $15.31Tier 04 Special RITALIN LA 10MG - CAPSULE, MULTIPHASIC RELEASE 50-50 30 $72.42Tier 04 Special RITALIN LA 20MG - CAPSULE, MULTIPHASIC RELEASE 50-50 30 $72.42Tier 04 Special RITALIN LA 30MG - CAPSULE, MULTIPHASIC RELEASE 50-50 30 $74.37Tier 04 Special RITALIN LA 40MG - CAPSULE, MULTIPHASIC RELEASE 50-50 30 $77.18Tier 04 Special RITALIN-SR 20MG - TABLET, SUSTAINED ACTION 30 $45.94Tier 03 Under $40 ROBINUL 1MG - TABLET 30 $39.07Tier 04 Special ROBINUL FORTE 2MG - TABLET 30 $65.21Tier 04 Special ROSANIL 10%-5% - CLEANSER (GM) 170 $43.38Tier 04 Special ROSULA 10-5%(W/W) - CLEANSER (GM) 355 $90.60

35

Tier Tier Price Drug Name and Dosage Qty PriceTier 01 Under $10 ROXICET 5-325MG - TABLET 30 $5.39Tier 04 Special RYTHMOL 150MG - TABLET 30 $77.62Tier 04 Special RYTHMOL SR 225MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $133.58Tier 04 Special RYTHMOL SR 425MG - CAPSULE, SUSTAINED RELEASE 12 HR 30 $175.82Tier 04 Special SALAGEN 5MG - TABLET 30 $47.52Tier 04 Special SALEX 6% - CREAM (GRAMS) 400 $80.96Tier 04 Special SALEX 6% - LOTION (ML) 414 $76.51Tier 01 Under $10 SALSALATE 500MG - TABLET 30 $3.68Tier 01 Under $10 SALSALATE 750MG - TABLET 30 $4.41Tier 03 Under $40 SANCTURA 20MG - TABLET 30 $39.34Tier 03 Under $40 SANTYL 250 UNIT/G - OINTMENT(GM) 15 $26.93Tier 04 Special SARAFEM 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $100.19Tier 04 Special SEASONALE 0.15-0.03 - TABLET, DOSE PACK, 3 MONTHS 30 $40.39Tier 01 Under $10 SELENIUM SULFIDE 2.5% - SHAMPOO 120 $8.81Tier 04 Special SEREVENT DISKUS 50MCG - DISK, WITH INHALATION DEVICE 60 $91.87Tier 04 Special SEROQUEL 100MG - TABLET 30 $85.80Tier 04 Special SEROQUEL 200MG - TABLET 30 $162.10Tier 04 Special SEROQUEL 25MG - TABLET 30 $49.10Tier 04 Special SEROQUEL 300MG - TABLET 30 $212.52Tier 01 Under $10 SILVER SULFADIAZINE 1% - CREAM (GRAMS) 25 $3.55Tier 04 Special SINGULAIR 10MG - TABLET 30 $86.59Tier 04 Special SINGULAIR 4MG - TABLET, CHEWABLE 30 $86.59Tier 04 Special SINGULAIR 5MG - TABLET, CHEWABLE 30 $86.59Tier 04 Special SKELAXIN 400MG - TABLET 30 $41.45Tier 04 Special SKELAXIN 800MG - TABLET 30 $69.70Tier 01 Under $10 SODIUM FLUORIDE 0.5MG - TABLET, CHEWABLE 30 $0.80Tier 01 Under $10 SODIUM FLUORIDE 0.5MG/ML - DROPS 50 $6.60Tier 01 Under $10 SODIUM FLUORIDE 1MG - TABLET, CHEWABLE 30 $0.80Tier 03 Under $40 SODIUM SULFACETAMIDE/SULFUR 10-5%(W/W) - LOTION (GM) 60 $25.64Tier 01 Under $10 SOFTCLIX - EACH 100 $8.80Tier 03 Under $40 SOLIA 0.15-0.03 - TABLET 30 $22.64Tier 04 Special SONATA 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $83.95Tier 04 Special SONATA 5MG - CAPSULE (HARD, SOFT, ETC.) 30 $68.11Tier 04 Special SOTRET 40MG - CAPSULE (HARD, SOFT, ETC.) 30 $208.25Tier 04 Special SPECTRACEF 200MG - TABLET 30 $54.91Tier 04 Special SPIRIVA 18MCG - CAPSULE, WITH INHALATION DEVICE 30 $105.60Tier 03 Under $40 SPIRONOLACTONE 100MG - TABLET 30 $28.39Tier 01 Under $10 SPIRONOLACTONE 25MG - TABLET 30 $6.47Tier 02 Under $20 SPIRONOLACTONE 50MG - TABLET 30 $12.30Tier 01 Under $10 SPIRONOLACTONE W/HCTZ 25MG-25MG - TABLET 30 $9.72Tier 04 Special SPORANOX 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $272.98Tier 03 Under $40 STARLIX 120MG - TABLET 30 $34.50Tier 04 Special STRATTERA 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $91.08Tier 04 Special STRATTERA 18MG - CAPSULE (HARD, SOFT, ETC.) 30 $91.08Tier 04 Special STRATTERA 25MG - CAPSULE (HARD, SOFT, ETC.) 30 $91.08

36

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special STRATTERA 40MG - CAPSULE (HARD, SOFT, ETC.) 30 $91.08Tier 04 Special STRATTERA 60MG - CAPSULE (HARD, SOFT, ETC.) 30 $91.08Tier 04 Special SUBOXONE 8MG-2MG - TABLET, SUBLINGUAL 30 $133.85Tier 02 Under $20 SUCRALFATE 1G - TABLET 30 $11.44Tier 02 Under $20 SUCRALFATE 1G - TABLET 30 $11.50Tier 03 Under $40 SUDAL SR 1200-50MG - TABLET, SUSTAINED RELEASE 12HR 30 $23.23Tier 04 Special SULAR 10MG - TABLET, SUSTAINED RELEASE 24HR 30 $40.39Tier 01 Under $10 SULFACETAMIDE SODIUM 10% - DROPS 15 $2.97Tier 01 Under $10 SULFACETAMIDE SODIUM 10% - OINTMENT(GM) 4 $3.27Tier 01 Under $10 SULFAMETHOXAZOLE/TRIMETHOPRIM 200-40MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 60 $5.10Tier 01 Under $10 SULFAMETHOXAZOLE/TRIMETHOPRIM 400-80MG - TABLET 30 $4.33Tier 01 Under $10 SULFAMETHOXAZOLE/TRIMETHOPRIM 800-160MG - TABLET 30 $4.60Tier 01 Under $10 SULFASALAZINE 500MG - TABLET 30 $5.43Tier 02 Under $20 SULFATRIM 200-40MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 150 $12.76Tier 01 Under $10 SULFAZINE EC 500MG - TABLET, DELAYED RELEASE (ENTERIC COATED) 30 $7.81Tier 02 Under $20 SULINDAC 150MG - TABLET 30 $10.79Tier 02 Under $20 SULINDAC 200MG - TABLET 30 $13.47Tier 04 Special SUMYCIN 125MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 488 $81.59Tier 03 Under $40 SUPRAX 100MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 50 $39.60Tier 04 Special SUSTIVA 600MG - TABLET 30 $427.15Tier 02 Under $20 SU-TUSS DM 200-20/5ML - ELIXIR 240 $12.24Tier 01 Under $10 SU-TUSS HD 100-30-2.5 - ELIXIR 180 $8.57Tier 04 Special SYNAGIS 100MG - VIAL (SDV,MDV OR ADDITIVE) (EA) 2 $2,542.48Tier 04 Special SYNAGIS 50MG - VIAL (SDV,MDV OR ADDITIVE) (EA) 1 $673.24Tier 02 Under $20 SYNTHROID 100MCG - TABLET 30 $12.14Tier 02 Under $20 SYNTHROID 112MCG - TABLET 30 $16.00Tier 02 Under $20 SYNTHROID 125MCG - TABLET 30 $16.33Tier 02 Under $20 SYNTHROID 150MCG - TABLET 30 $16.70Tier 02 Under $20 SYNTHROID 175MCG - TABLET 30 $19.62Tier 02 Under $20 SYNTHROID 200MCG - TABLET 30 $19.54Tier 02 Under $20 SYNTHROID 25MCG - TABLET 30 $10.82Tier 03 Under $40 SYNTHROID 300MCG - TABLET 30 $27.19Tier 02 Under $20 SYNTHROID 50MCG - TABLET 30 $12.38Tier 02 Under $20 SYNTHROID 75MCG - TABLET 30 $13.63Tier 02 Under $20 SYNTHROID 88MCG - TABLET 30 $13.61Tier 01 Under $10 SYRINGE 25GX1" - SYRINGE, EMPTY DISPOSABLE 50 $6.16Tier 02 Under $20 SYRINGE 30 GAUGE - SYRINGE, EMPTY DISPOSABLE 100 $17.60Tier 01 Under $10 SYRINGE W/NEEDLE 23GX1" - SYRINGE, EMPTY DISPOSABLE 24 $3.80Tier 03 Under $40 TALACEN 25-650MG - TABLET 30 $34.85Tier 03 Under $40 TAMIFLU 12MG/ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 25 $33.66Tier 04 Special TAMIFLU 75MG - CAPSULE (HARD, SOFT, ETC.) 30 $202.22Tier 03 Under $40 TAMOXIFEN CITRATE 10MG - TABLET 30 $25.76Tier 03 Under $40 TAMOXIFEN CITRATE 20MG - TABLET 30 $38.69Tier 04 Special TANAFED DMX 25-75-2.5 - SUSPENSION, ORAL (FINAL DOSE FORM) 120 $47.52Tier 04 Special TANAFED DP 75-2.5MG/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 120 $48.58

37

Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 TANNIC-12 60-5MG - TABLET 30 $32.51Tier 04 Special TARKA 2-180MG - TABLET, MULTIPHASIC RELEASE 30 $57.02Tier 04 Special TARKA 2-240MG - TABLET, MULTIPHASIC RELEASE 30 $57.02Tier 04 Special TARKA 4-240MG - TABLET, MULTIPHASIC RELEASE 30 $59.40Tier 04 Special TAZORAC 0.05% - CREAM (GRAMS) 30 $85.71Tier 04 Special TAZORAC 0.1% - CREAM (GRAMS) 30 $90.90Tier 04 Special TAZORAC 0.1% - GEL (GM) 30 $88.35Tier 03 Under $40 TAZTIA XT 240MG - CAPSULE, SUSTAINED ACTION 30 $39.59Tier 04 Special TEBAMIDE 200MG - SUPPOSITORY, RECTAL 60 $44.30Tier 02 Under $20 TEGRETOL XR 200MG - TABLET, SUSTAINED RELEASE 12HR 30 $17.42Tier 03 Under $40 TEGRETOL XR 400MG - TABLET, SUSTAINED RELEASE 12HR 30 $34.58Tier 01 Under $10 TEMAZEPAM 15MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.76Tier 01 Under $10 TEMAZEPAM 30MG - CAPSULE (HARD, SOFT, ETC.) 30 $5.41Tier 04 Special TEQUIN 200MG - TABLET 30 $270.86Tier 04 Special TEQUIN 400MG - TABLET 30 $263.21Tier 04 Special TERAZOL 3 80MG - SUPPOSITORY, VAGINAL 3 $44.04Tier 04 Special TERAZOL 7 0.4% - CREAM WITH APPLICATOR 45 $41.98Tier 02 Under $20 TERAZOSIN HCL 10MG - CAPSULE (HARD, SOFT, ETC.) 30 $18.68Tier 02 Under $20 TERAZOSIN HCL 2MG - CAPSULE (HARD, SOFT, ETC.) 30 $12.69Tier 02 Under $20 TERAZOSIN HCL 5MG - CAPSULE (HARD, SOFT, ETC.) 30 $12.94Tier 04 Special TESTIM 1%(50MG) - GEL IN PACKET (GM) 150 $176.88Tier 01 Under $10 TETRACYCLINE HCL 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $1.61Tier 01 Under $10 TETRACYCLINE HCL 500MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.81Tier 03 Under $40 TEVETEN 600MG - TABLET 30 $39.86Tier 04 Special TEVETEN HCT 600-12.5MG - TABLET 30 $43.82Tier 04 Special TEVETEN HCT 600-25MG - TABLET 30 $43.82Tier 01 Under $10 THEOPHYLLINE ANHYDROUS 200MG - TABLET, SUSTAINED RELEASE 12HR 30 $6.57Tier 01 Under $10 THEOPHYLLINE ANHYDROUS 300MG - TABLET, SUSTAINED RELEASE 12HR 30 $7.51Tier 01 Under $10 THIN LANCETS - EACH 100 $5.28Tier 01 Under $10 THIORIDAZINE HCL 10MG - TABLET 30 $4.82Tier 01 Under $10 THIORIDAZINE HCL 25MG - TABLET 30 $5.82Tier 01 Under $10 THYROID 120MG - TABLET 30 $1.04Tier 01 Under $10 THYROID 60MG - TABLET 30 $3.03Tier 01 Under $10 THYROID 90MG - TABLET 30 $4.98Tier 01 Under $10 TIMOLOL MALEATE 0.25% - DROPS 10 $8.19Tier 03 Under $40 TIMOLOL MALEATE 0.5% - GEL-FORMING SOLUTION 5 $27.29Tier 04 Special TINDAMAX 500MG - TABLET 30 $125.40Tier 02 Under $20 TIZANIDINE HCL 2MG - TABLET 30 $19.27Tier 02 Under $20 TIZANIDINE HCL 4MG - TABLET 30 $19.25Tier 04 Special TOBI 300MG/5ML - AMPUL FOR NEBULIZATION (ML) 280 $2,934.62Tier 04 Special TOBRADEX 0.3-0.1% - OINTMENT(GM) 4 $69.94Tier 04 Special TOBRADEX 0.3-0.1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $55.61Tier 01 Under $10 TOBRAMYCIN SULFATE 0.3% - DROPS 5 $5.40Tier 04 Special TOBREX 0.3% - OINTMENT(GM) 4 $59.98Tier 04 Special TOPAMAX 100MG - TABLET 30 $127.25

38

Tier Tier Price Drug Name and Dosage Qty Price

Tier 04 Special TOPAMAX 200MG - TABLET 30 $140.71Tier 04 Special TOPAMAX 25MG - TABLET 30 $48.58Tier 04 Special TOPAMAX 50MG - TABLET 30 $96.62Tier 04 Special TOPICORT 0.25% - CREAM (GRAMS) 30 $72.86Tier 03 Under $40 TOPROL XL 100MG - TABLET, SUSTAINED RELEASE 24HR 30 $35.11Tier 04 Special TOPROL XL 200MG - TABLET, SUSTAINED RELEASE 24HR 30 $55.97Tier 03 Under $40 TOPROL XL 25MG - TABLET, SUSTAINED RELEASE 24HR 30 $23.50Tier 03 Under $40 TOPROL XL 50MG - TABLET, SUSTAINED RELEASE 24HR 30 $23.50Tier 01 Under $10 TRAMADOL HCL 50MG - TABLET 30 $7.78Tier 03 Under $40 TRANSDERM-SCOP 1.5MG/72HR - PATCH, TRANSDERMAL 72 HOURS 4 $24.04Tier 04 Special TRAVATAN 0.004% - DROPS 3 $65.68Tier 01 Under $10 TRAZODONE HCL 100MG - TABLET 30 $4.30Tier 02 Under $20 TRAZODONE HCL 150MG - TABLET 30 $10.85Tier 01 Under $10 TRAZODONE HCL 50MG - TABLET 30 $1.60Tier 01 Under $10 TRIAMCINOLONE ACETONIDE 0.025% - CREAM (GRAMS) 15 $0.67Tier 01 Under $10 TRIAMCINOLONE ACETONIDE 0.1% - CREAM (GRAMS) 15 $0.84Tier 01 Under $10 TRIAMCINOLONE ACETONIDE 0.5% - CREAM (GRAMS) 30 $8.33Tier 01 Under $10 TRIAMTERENE W/HCTZ 37.5-25MG - CAPSULE (HARD, SOFT, ETC.) 30 $5.23Tier 01 Under $10 TRIAMTERENE W/HCTZ 37.5-25MG - TABLET 30 $3.96Tier 01 Under $10 TRIAMTERENE W/HCTZ 75-50MG - TABLET 30 $1.82Tier 03 Under $40 TRIAZ 3% - GEL (GM) 43 $37.46Tier 03 Under $40 TRIAZ 6% - CLEANSER (GM) 180 $36.43Tier 04 Special TRIAZ 6% - PADS, MEDICATED (EA) 60 $117.74Tier 01 Under $10 TRIAZOLAM 0.125MG - TABLET 30 $9.15Tier 02 Under $20 TRIAZOLAM 0.25MG - TABLET 30 $13.01Tier 04 Special TRICOR 145MG - TABLET 30 $92.93Tier 04 Special TRICOR 160MG - TABLET 30 $92.93Tier 03 Under $40 TRICOR 48MG - TABLET 30 $30.89Tier 03 Under $40 TRIFLUOPERAZINE HCL 10MG - TABLET 30 $34.85Tier 02 Under $20 TRIFLUOPERAZINE HCL 2MG - TABLET 30 $16.47Tier 03 Under $40 TRILEPTAL 150MG - TABLET 30 $31.68Tier 04 Special TRILEPTAL 300MG - TABLET 30 $57.82Tier 04 Special TRILEPTAL 300MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 250 $96.80Tier 04 Special TRILEPTAL 600MG - TABLET 30 $106.13Tier 04 Special TRI-LUMA 0.01-.05-4 - CREAM (GRAMS) 30 $81.31Tier 02 Under $20 TRIMETHOPRIM 100MG - TABLET 30 $13.32Tier 01 Under $10 TRIMOX 250 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $2.70Tier 01 Under $10 TRIMOX 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $2.39Tier 03 Under $40 TRINESSA 7 DAYS X 3 - TABLET 30 $29.33Tier 03 Under $40 TRIPHASIL-28 6-5-10 - TABLET 30 $33.26Tier 03 Under $40 TRI-PREVIFEM 7 DAYS X 3 - TABLET 30 $29.33Tier 01 Under $10 TRI-VENT DM 100-15-40 - SYRUP 120 $6.06Tier 03 Under $40 TRIVORA-28 6-5-10 - TABLET 30 $20.74Tier 04 Special TRIZIVIR 150-300MG - TABLET 30 $528.44

39

Tier Tier Price Drug Name and Dosage Qty PriceTier 03 Under $40 TRUETRACK - STRIP 50 $26.84Tier 03 Under $40 TRUETRACK SMART SYSTEM - KIT 1 $20.86Tier 04 Special TUSSI-12 60-5MG - TABLET 30 $59.14Tier 04 Special TUSSI-12 S 30-4MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 118 $46.73Tier 04 Special TUSSI-12D 60-10-40MG - TABLET 30 $49.10Tier 03 Under $40 TUSSI-12D S 30-5-30/5 - SUSPENSION, ORAL (FINAL DOSE FORM) 118 $39.46Tier 03 Under $40 TUSSI-BID 1200-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $20.89Tier 02 Under $20 TUSSIONEX 10-8MG/5ML - SUSPENSION, 12 HR SUSTAINED RELEASE 45 $18.61Tier 03 Under $40 TUSSIZONE-12 RF 60-5MG - TABLET 30 $27.57Tier 03 Under $40 TYLOX 5-500MG - CAPSULE (HARD, SOFT, ETC.) 30 $35.64Tier 03 Under $40 ULTRA FINE 30GX0.5" - SYRINGE, EMPTY DISPOSABLE 100 $23.76Tier 03 Under $40 ULTRA FINE II 31GX0.312" - SYRINGE, EMPTY DISPOSABLE 90 $21.38Tier 01 Under $10 ULTRA NATALCARE 90-1MG - TABLET 30 $4.86Tier 01 Under $10 ULTRA NATALCARE 90-1MG - TABLET 30 $5.10Tier 03 Under $40 ULTRACET 37.5-325MG - TABLET 30 $30.10Tier 03 Under $40 ULTRAM 50MG - TABLET 30 $33.00Tier 04 Special ULTRASE MT 20 65-20-65 - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $48.31Tier 04 Special ULTRAVATE 0.05% - CREAM (GRAMS) 50 $76.56Tier 03 Under $40 UNIPHYL 400MG - TABLET, SUSTAINED ACTION 30 $31.15Tier 03 Under $40 UNIRETIC 15-25MG - TABLET 30 $31.42Tier 01 Under $10 UNITHROID 100MCG - TABLET 30 $7.99Tier 02 Under $20 UNITHROID 175MCG - TABLET 30 $10.80Tier 01 Under $10 UNITHROID 25MCG - TABLET 30 $5.85Tier 01 Under $10 UNITHROID 50MCG - TABLET 30 $6.30Tier 03 Under $40 UNIVASC 15MG - TABLET 30 $35.11Tier 03 Under $40 UNIVASC 7.5MG - TABLET 30 $35.11Tier 03 Under $40 URELLE 81-0.12MG - TABLET 30 $27.72Tier 02 Under $20 URISED - TABLET 30 $16.10Tier 02 Under $20 URISED - TABLET 30 $16.37Tier 02 Under $20 URISED - TABLET 30 $16.37Tier 01 Under $10 UROCIT-K 1080MG - TABLET, SUSTAINED ACTION 30 $9.24Tier 04 Special UROXATRAL 10MG - TABLET, SUSTAINED RELEASE 24HR 30 $49.10Tier 04 Special URSO 250MG - TABLET 30 $61.78Tier 04 Special URSO FORTE 500MG - TABLET 30 $117.48

Tier 04 Special URSODIOL 300MG - CAPSULE (HARD, SOFT, ETC.) 30 $60.12Tier 04 Special VAGIFEM 25MCG - TABLET 30 $88.97Tier 04 Special VAGIFEM 25MCG - TABLET 30 $91.48Tier 04 Special VALCYTE 450MG - TABLET 30 $872.52Tier 04 Special VALIUM 10MG - TABLET 30 $78.67Tier 04 Special VALIUM 5MG - TABLET 30 $46.73Tier 02 Under $20 VALPROIC ACID 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $11.49Tier 02 Under $20 VALPROIC ACID 250MG/5ML - SYRUP 240 $17.39Tier 04 Special VALTREX 1000MG - TABLET 30 $246.84Tier 04 Special VALTREX 500MG - TABLET 30 $129.62

40

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special VANCOCIN HCL 125MG - CAPSULE (HARD, SOFT, ETC.) 30 $252.91Tier 04 Special VANCOCIN HCL 250MG - CAPSULE (HARD, SOFT, ETC.) 30 $486.82Tier 04 Special VANTIN 100MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 50 $48.84Tier 04 Special VANTIN 50MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 100 $48.40Tier 03 Under $40 VASOTEC 5MG - TABLET 30 $31.42Tier 01 Under $10 VEETIDS 250 250MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 200 $4.22Tier 03 Under $40 VERAPAMIL HCL 120MG - CAPSULE, 24HR SUSTAINED RELEASE PELLETS 30 $25.19Tier 01 Under $10 VERAPAMIL HCL 120MG - TABLET 30 $3.60Tier 03 Under $40 VERAPAMIL HCL 120MG - TABLET, SUSTAINED ACTION 30 $21.75Tier 02 Under $20 VERAPAMIL HCL 180MG - TABLET, SUSTAINED ACTION 30 $13.88Tier 03 Under $40 VERAPAMIL HCL 240MG - CAPSULE, 24HR SUSTAINED RELEASE PELLETS 30 $26.29Tier 02 Under $20 VERAPAMIL HCL 240MG - TABLET, SUSTAINED ACTION 30 $12.52Tier 04 Special VERELAN PM 200MG - CAPSULE, 24HR SUSTAINED RELEASE PELLETS 30 $53.59Tier 04 Special VERELAN PM 300MG - CAPSULE, 24HR SUSTAINED RELEASE PELLETS 30 $77.88Tier 03 Under $40 VEXOL 1% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $29.04Tier 04 Special VIAGRA 100MG - TABLET 30 $280.63Tier 04 Special VIAGRA 50MG - TABLET 30 $287.63Tier 03 Under $40 VICODIN 5-500MG - TABLET 30 $20.59Tier 04 Special VICOPROFEN 200-7.5MG - TABLET 30 $42.50Tier 04 Special VIGAMOX 0.5% - DROPS 3 $47.99Tier 01 Under $10 VINATE GT 90-1MG - TABLET 30 $5.16Tier 01 Under $10 VI-Q-TUSS 100-5/5ML - SYRUP 120 $2.39Tier 04 Special VIRACEPT 625MG - TABLET 30 $166.58Tier 04 Special VIRAMUNE 200MG - TABLET 30 $186.38Tier 03 Under $40 VIRAVAN DM 25-12.5-30 - SUSPENSION, ORAL (FINAL DOSE FORM) 75 $27.06Tier 04 Special VIRAVAN DM 25-25-30MG - TABLET, CHEWABLE 30 $51.48Tier 04 Special VIREAD 300MG - TABLET 30 $437.71Tier 04 Special VISICOL 1.5G - TABLET 30 $42.24Tier 03 Under $40 VISTARIL 25MG/5ML - SUSPENSION, ORAL (FINAL DOSE FORM) 80 $26.05Tier 03 Under $40 VIVELLE 0.05MG/24H - PATCH, TRANSDERMAL BIWEEKLY 8 $35.48Tier 01 Under $10 VIVELLE-DOT .025MG/24H - PATCH, TRANSDERMAL BIWEEKLY 8 $32.60Tier 03 Under $40 VIVELLE-DOT .0375MG/24 - PATCH, TRANSDERMAL BIWEEKLY 8 $34.46Tier 03 Under $40 VIVELLE-DOT .075MG/24H - PATCH, TRANSDERMAL BIWEEKLY 8 $35.90Tier 03 Under $40 VIVELLE-DOT 0.05MG/24H - PATCH, TRANSDERMAL BIWEEKLY 8 $35.16Tier 03 Under $40 VIVELLE-DOT 0.1MG/24HR - PATCH, TRANSDERMAL BIWEEKLY 8 $36.34Tier 04 Special VIVOTIF BERNA - CAPSULE,DELAYED RELEASE (ENTERIC COATED) 30 $282.74Tier 03 Under $40 VOSPIRE ER 4MG - TABLET, SUSTAINED RELEASE 12HR 30 $28.51Tier 03 Under $40 VOSPIRE ER 4MG - TABLET, SUSTAINED RELEASE 12HR 30 $28.51Tier 04 Special VYTORIN 10-10MG - TABLET 30 $77.35Tier 04 Special VYTORIN 10-20MG - TABLET 30 $77.35Tier 04 Special VYTORIN 10MG-40MG - TABLET 30 $77.35Tier 04 Special VYTORIN 10MG-80MG - TABLET 30 $77.35Tier 03 Under $40 WARFARIN SODIUM 10MG - TABLET 30 $20.33Tier 02 Under $20 WARFARIN SODIUM 1MG - TABLET 30 $13.25Tier 02 Under $20 WARFARIN SODIUM 2.5MG - TABLET 30 $11.74

41

Tier Tier Price Drug Name and Dosage Qty PriceTier 02 Under $20 WARFARIN SODIUM 2MG - TABLET 30 $15.36Tier 02 Under $20 WARFARIN SODIUM 3MG - TABLET 30 $12.83Tier 02 Under $20 WARFARIN SODIUM 5MG - TABLET 30 $11.94Tier 03 Under $40 WARFARIN SODIUM 6MG - TABLET 30 $20.21Tier 03 Under $40 WARFARIN SODIUM 7.5MG - TABLET 30 $20.21Tier 01 Under $10 WE ALLERGY 10-2-0.625 - SYRUP 300 $8.42Tier 03 Under $40 WELCHOL 625MG - TABLET 30 $26.14Tier 04 Special WELLBUTRIN SR 150MG - TABLET, SUSTAINED ACTION 30 $59.66Tier 04 Special WELLBUTRIN XL 150MG - TABLET, SUSTAINED RELEASE 24HR 30 $84.74Tier 04 Special WELLBUTRIN XL 300MG - TABLET, SUSTAINED RELEASE 24HR 30 $111.94Tier 04 Special XALATAN 0.005% - DROPS 3 $64.12Tier 03 Under $40 XANAX 0.25MG - TABLET 30 $29.57Tier 03 Under $40 XANAX 0.5MG - TABLET 30 $35.11Tier 04 Special XANAX 1MG - TABLET 30 $49.37Tier 04 Special XANAX XR 0.5MG - TABLET, SUSTAINED RELEASE 24HR 30 $58.21Tier 04 Special XANAX XR 2MG - TABLET, SUSTAINED RELEASE 24HR 30 $98.47Tier 01 Under $10 XERAC AC 6.25% - SOLUTION, NON-ORAL 60 $7.39Tier 04 Special XIFAXAN 200MG - TABLET 30 $99.00Tier 04 Special XOPENEX 0.63MG/3ML - SOLUTION, NON-ORAL 72 $59.89Tier 04 Special XOPENEX 1.25MG/3ML - SOLUTION, NON-ORAL 72 $60.72Tier 03 Under $40 XPECT-AT 600MG-60MG - TABLET, SUSTAINED RELEASE 12HR 30 $26.40Tier 03 Under $40 XPECT-HC 600MG-5MG - TABLET, SUSTAINED RELEASE 12HR 30 $26.40Tier 02 Under $20 XYLOCAINE 2% - JEL (ML) 30 $18.22Tier 03 Under $40 YASMIN 28 0.03-3MG - TABLET 30 $38.77Tier 03 Under $40 ZANTAC 15MG/ML - SYRUP 45 $22.97Tier 04 Special ZEGERID 20MG - PACKET 60 $256.61Tier 04 Special ZEGERID 40MG - PACKET 30 $128.30Tier 04 Special ZELNORM 6MG - TABLET 30 $77.62Tier 04 Special ZETIA 10MG - TABLET 30 $74.54Tier 03 Under $40 ZITHROMAX 100MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 15 $31.86Tier 03 Under $40 ZITHROMAX 200MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 15 $32.10Tier 04 Special ZITHROMAX 250MG - TABLET 6 $44.59Tier 04 Special ZITHROMAX 500MG - TABLET 6 $90.69Tier 04 Special ZITHROMAX 600MG - TABLET 6 $107.87Tier 04 Special ZOCOR 10MG - TABLET 30 $75.24Tier 04 Special ZOCOR 20MG - TABLET 30 $130.94Tier 04 Special ZOCOR 40MG - TABLET 30 $130.94Tier 04 Special ZOCOR 80MG - TABLET 30 $130.94Tier 04 Special ZODERM 4.5%-10% - CREAM (MILLILITERS) 125 $84.70Tier 04 Special ZOFRAN 4MG - TABLET 30 $606.41Tier 04 Special ZOFRAN 8MG - TABLET 30 $1,009.80Tier 04 Special ZOFRAN ODT 4MG - TABLET, RAPID DISSOLVE 30 $571.82Tier 04 Special ZOFRAN ODT 8MG - TABLET, RAPID DISSOLVE 30 $952.78Tier 04 Special ZOLOFT 100MG - TABLET 30 $75.77Tier 04 Special ZOLOFT 25MG - TABLET 30 $75.77

42

Tier Tier Price Drug Name and Dosage Qty PriceTier 04 Special ZOLOFT 50MG - TABLET 30 $75.77Tier 04 Special ZOMIG 2.5MG - TABLET 30 $485.50Tier 04 Special ZOMIG 5MG - SPRAY, NON-AEROSOL (EA) 12 $286.60Tier 04 Special ZOMIG 5MG - TABLET 30 $536.45Tier 04 Special ZOMIG ZMT 2.5MG - TABLET, RAPID DISSOLVE 30 $485.50Tier 04 Special ZONEGRAN 100MG - CAPSULE (HARD, SOFT, ETC.) 30 $62.57Tier 02 Under $20 ZONEGRAN 25MG - CAPSULE (HARD, SOFT, ETC.) 30 $16.10Tier 04 Special ZOVIRAX 5% - CREAM (GRAMS) 5 $75.81Tier 03 Under $40 ZOVIRAX 5% - OINTMENT(GM) 3 $23.34Tier 04 Special ZYLET 0.3%-0.5% - SUSPENSION, DROPS(FINAL DOSAGE FORM)(ML) 5 $57.42Tier 03 Under $40 ZYMAR 0.3% - DROPS 3 $28.38Tier 04 Special ZYPREXA 10MG - TABLET 30 $285.12Tier 04 Special ZYPREXA 15MG - TABLET 30 $427.68Tier 04 Special ZYPREXA 2.5MG - TABLET 30 $160.25Tier 04 Special ZYPREXA 5MG - TABLET 30 $189.29Tier 04 Special ZYPREXA 7.5MG - TABLET 30 $230.21Tier 04 Special ZYRTEC 10MG - TABLET 30 $60.46Tier 04 Special ZYRTEC 10MG - TABLET, CHEWABLE 30 $60.40Tier 02 Under $20 ZYRTEC 1MG/ML - SYRUP 75 $18.15Tier 04 Special ZYRTEC 5MG - TABLET 30 $60.98Tier 04 Special ZYRTEC 5MG - TABLET, CHEWABLE 30 $58.08Tier 03 Under $40 ZYRTEC-D 120-5MG - TABLET, SUSTAINED RELEASE 12HR 30 $30.03Tier 04 Special ZYVOX 100MG/5ML - SUSPENSION, RECONSTITUTED, ORAL (ML) 900 $1,782.00Tier 04 Special ZYVOX 600MG - TABLET 30 $1,700.69

43