Prescription Drug Formulary and Network Pharmacies

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1 205 Prescription Formulary and Network Pharmacies H5826_MA_254_205_v_02_FormularyPharmacytier Accepted Offered by

2 Community HealthFirst MA Special Needs Plan (HMO SNP) 205 Prescription Formulary (List of Covered s) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN HPMS approved formulary file submission ID , Version 6, Approved 08/08/204 This formulary was updated on 08/22/204. For more recent information or other questions, please contact Community Health Plan of Washington at or for TTY users, Dial 7--, 7 days a week, 8am 8pm or visit Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. When this drug list (formulary) refers to we, us, or our, it means Community Health Plan of Washington.. When it refers to plan or our plan, it means Community HealthFirst MA Special Needs Plan. This document includes a list of the drugs (formulary) for our plan which is current as of October, 204. For an updated formulary, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You must generally use network pharmacies to use your prescription drug benefit. Benefits, formulary, pharmacy network, and/or copayments/coinsurance may change on January, 205 and from time to time during the year. Community Health Plan of of WWashington is is a Coordinated Care Plan with a Medicare Advantage contract. Enrollment and a contract in Community with the Washington Health Plan State of W Mashington edicaid depends Program. on Enrollment contract renewal. in Community Health Plan of Washington depends on contract renewal. H5826_MA_254_205_v_0 MAM_254_205_v0_F 2_FormularyPharmacytier

3 What is the Community HealthFirst MA Special Needs Plan Formulary? A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a Community HealthFirst MA Special Needs Plan network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage. Can the Formulary (drug list) change? Generally, if you are taking a drug on our 205 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the 205 coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. If we remove drugs from our formulary, [or] add prior authorization, quantity limits and/or step therapy restrictions on a drug [or move a drug to a higher cost-sharing tier], we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. The enclosed formulary is current as of October, 204. To get updated information about the drugs covered by Community HealthFirst MA Special Needs Plan, please contact us. Our contact information appears on the front and back cover pages. We regularly review and update the formulary. The notice of these changes is posted monthly at How do I use the Formulary? There are two ways to find your drug within the formulary: 2

4 Medical Condition The formulary begins on page 8. The drugs in this formulary are grouped into categories depending on the type of medical conditions that they are used to treat. For example, drugs used to treat a heart condition are listed under the category, Cardiovascular, Hypertension/ Lipids. If you know what your drug is used for, look for the category name in the list that begins on page number 8. Then look under the category name for your drug. Alphabetical Listing If you are not sure what category to look under, you should look for your drug in the Index that begins on page 6. The Index provides an alphabetical list of all of the drugs included in this document. Both brand name drugs and generic drugs are listed in the Index. Look in the Index and find your drug. Next to your drug, you will see the page number where you can find coverage information. Turn to the page listed in the Index and find the name of your drug in the first column of the list. What are generic drugs? Community HealthFirst MA Special Needs Plan covers both brand name drugs and generic drugs. A generic drug is approved by the FDA as having the same active ingredient as the brand name drug. Generally, generic drugs cost less than brand name drugs. Are there any restrictions on my coverage? Some covered drugs may have additional requirements or limits on coverage. These requirements and limits may include: Prior Authorization: Community HealthFirst MA Special Needs Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval from our plan before you fill your prescriptions. If you don t get approval, our plan may not cover the drug. Quantity Limits: For certain drugs, Community HealthFirst MA Special Needs Plan limits the amount of the drug that our plan will cover. For example, our plan provides 68 tablets per prescription for bupropion hcl. This may be in addition to a standard one-month or three-month supply. Step Therapy: In some cases, Community HealthFirst MA Special Needs Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if A and B both treat your medical condition, our plan may not cover B unless you try A first. If A does not work for you, we will then cover B. 3

5 You can find out if your drug has any additional requirements or limits by looking in the formulary that begins on page 8. You can also get more information about the restrictions applied to specific covered drugs by visiting our Web site. We have posted on line documents that explain our prior authorization and step therapy restrictions. You may also ask us to send you a copy. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. You can ask Community HealthFirst MA Special Needs Plan to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. See the section, How do I request an exception to the Community HealthFirst MA Special Needs Plan s formulary? on page 4 for information about how to request an exception. What if my drug is not on the Formulary? If your drug is not included in this formulary (list of covered drugs), you should first contact Member Services and ask if your drug is covered. If you learn that Community HealthFirst MA Special Needs Plan does not cover your drug, you have two options: You can ask Member Services for a list of similar drugs that are covered by Community HealthFirst MA Special Needs Plan. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by our plan. You can ask Community HealthFirst MA Special Needs Plan to make an exception and cover your drug. See below for information about how to request an exception. How do I request an exception to the Community HealthFirst MA Special Needs Plan s Formulary? You can ask us to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover a drug even if it is not on our formulary. If approved, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level. You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, our plan limits the amount of the drug that we will cover. If your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount. Generally, Community HealthFirst MA Special Needs Plan will only approve your request for an exception if the alternative drugs included on the plan s formulary or 4

6 additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. You should contact us to ask us for an initial coverage decision for a formulary or utilization restriction exception. When you request a formulary or utilization restriction exception you should submit a statement from your prescriber or physician supporting your request. Generally, we must make our decision within 72 hours of getting your prescriber s supporting statement. You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. If your request to expedite is granted, we must give you a decision no later than 24 hours after we get a supporting statement from your doctor or other prescriber. What do I do before I can talk to my doctor about changing my drugs or requesting an exception? As a new or continuing member in our plan you may be taking drugs that are not on our formulary. Or, you may be taking a drug that is on our formulary but your ability to get it is limited. For example, you may need a prior authorization from us before you can fill your prescription. You should talk to your doctor to decide if you should switch to an appropriate drug that we cover or request a formulary exception so that we will cover the drug you take. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. For each of your drugs that is not on our formulary or if your ability to get your drugs is limited, we will cover a temporary 34-day supply (unless you have a prescription written for fewer days) when you go to a network pharmacy. After your first 34-day supply, we will not pay for these drugs, even if you have been a member of the plan less than 90 days. If you are a resident of a long-term care facility, we will allow you to refill your prescription until we have provided you with a 9 and may be up to 98-day transition supply, consistent with dispensing increment, (unless you have a prescription written for fewer days). We will cover more than one refill of these drugs for the first 90 days you are a member of our plan. If you need a drug that is not on our formulary or if your ability to get your drugs is limited, but you are past the first 90days of membership in our plan, we will cover a 34-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception. Community HealthFirst MA Special Needs Plan will extend an override to current enrollees who experience level of care changes, such as a change in treatment settings. This allowance will be made for the 30-day period following the level of care change. 5

7 For more information For more detailed information about your Community HealthFirst MA Special Needs Plan prescription drug coverage, please review your Evidence of Coverage and other plan materials. If you have questions about Community HealthFirst MA Special Needs Plan, please contact us. Our contact information, along with the date we last updated the formulary, appears on the front and back cover pages. If you have general questions about Medicare prescription drug coverage, please call Medicare at -800-MEDICARE ( ) 24 hours a day/7 days a week. TTY users should call Or, visit Community HealthFirst MA Special Needs Plan s Formulary The formulary that begins on page 8 provides coverage information about the drugs covered by our plan. If you have trouble finding your drug in the list, turn to the Index that begins on page 6. The first column of the chart lists the drug name. Brand name drugs are capitalized (e.g., CRESTOR and generic drugs are listed in lower-case italics (e.g., simvastatin.) The information in the column tells you if Community HealthFirst MA Special Needs Plan has any special requirements for coverage of your drug. 6

8 Below is a list of abbreviations that may appear on the following pages in the column that tells you if there are any special requirements for coverage of your drug. List of Abbreviations B/D PA: This prescription drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination. LA: Limited Availability. This prescription may be available only at certain pharmacies. For more information, please call Customer Service. MO: Mail-Order. This prescription drug is available through our mail-order service, as well as through our retail network pharmacies. Consider using mail order for your long-term (maintenance) medications (such as high blood pressure medications). Retail network pharmacies may be more appropriate for short-term prescriptions (such as antibiotics). PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs. This means that you will need to get approval before you fill your prescriptions. If you don t get approval, we may not cover the drug. QL: Quantity Limit. For certain drugs, the Plan limits the amount of the drug that we will cover. ST: Step Therapy. In some cases, the Plan requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if A and B both treat your medical condition, we may not cover B unless you try A first. If A does not work for you, we will then cover B. 7

9 Name ANTI - INFECTIVES ANTIFUNGAL AGENTS ABELCET B/D PA; MO AMBISOME B/D PA; MO amphotericin b B/D PA; MO CANCIDAS B/D PA; MO clotrimazole mucous membrane fluconazole fluconazole in dextrose(iso-o) intravenous piggyback 400 mg/200 ml flucytosine griseofulvin microsize griseofulvin ultramicrosize itraconazole ; QL (20 ketoconazole oral LAMISIL ORAL GRANULES IN PACKET MYCAMINE NOXAFIL ORAL nystatin oral suspension nystatin oral tablet SPORANOX ORAL SOLUTION terbinafine oral voriconazole ANTIVIRALS You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 8 Name abacavir abacavirlamivudinezidovudine acyclovir oral acyclovir sodium intravenous solution B/D PA adefovir amantadine hcl oral APTIVUS ORAL CAPSULE APTIVUS ORAL SOLUTION ATRIPLA BARACLUDE cidofovir B/D PA; MO COMPLERA CRIXIVAN didanosine EDURANT EMTRIVA EPIVIR ORAL SOLUTION EPIVIR HBV ORAL SOLUTION EPZICOM famciclovir foscarnet B/D PA; MO FUZEON ganciclovir sodium INTELENCE ORAL TABLET 00 MG, 200 MG

10 Name INTELENCE ORAL TABLET 25 MG INVIRASE ISENTRESS ORAL POWDER IN PACKET ISENTRESS ORAL TABLET ISENTRESS ORAL TABLET,CHEWAB LE KALETRA lamivudine lamivudinezidovudine LEXIVA MODERIBA MODERIBA DOSE PACK ORAL TABLETS,DOSE PACK 400 MG (7)- 400 MG (7), 600 MG (7)- 600 MG (7) nevirapine NORVIR OLYSIO PA; MO PREZISTA ORAL SUSPENSION PREZISTA ORAL TABLET 50 MG, 600 MG, 75 MG, 800 MG RELENZA DISKHALER ; QL (60 per 80 days) RESCRIPTOR RETROVIR INTRAVENOUS You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 9 Name REYATAZ RIBAPAK DOSE PACK ORAL TABLETS,DOSE PACK MG (28)-MG (28), MG (28)-MG (28), MG (28)-MG (28) RIBASPHERE ORAL CAPSULE RIBASPHERE ORAL TABLET 200 MG, 600 MG RIBASPHERE ORAL TABLET 400 MG ribavirin rimantadine SELZENTRY SOVALDI PA; MO stavudine STRIBILD SUSTIVA SYNAGIS INTRAMUSCULA R SOLUTION 50 MG/0.5 ML TAMIFLU ORAL CAPSULE 30 MG TAMIFLU ORAL CAPSULE 45 MG, 75 MG TAMIFLU ORAL SUSPENSION FOR RECONSTITUTIO N ; LA ; QL (84 per 80 days) ; QL (42 per 80 days) ; QL (600 per 80 days) TIVICAY

11 Name TRUVADA TYZEKA valacyclovir ; QL (30 VALCYTE VICTRELIS VIDEX 2 GRAM PEDIATRIC VIRACEPT VIRAMUNE XR ORAL TABLET EXTENDED RELEASE 24 HR 00 MG VIRAZOLE VIREAD ZIAGEN ORAL SOLUTION zidovudine CEPHALOSPORINS cefaclor cefadroxil cefazolin injection recon soln gram cefazolin injection recon soln 0 gram, 500 mg cefazolin in dextrose (iso-os) intravenous piggyback gram/50 ml cefdinir cefditoren pivoxil cefepime Name cefotaxime injection recon soln gram, 2 gram, 500 mg cefotaxime injection recon soln 0 gram cefotetan cefoxitin intravenous recon soln gram cefoxitin intravenous recon soln 0 gram, 2 gram cefoxitin in dextrose, iso-osm cefpodoxime cefprozil ceftazidime injection recon soln gram, 6 gram ceftazidime injection recon soln 2 gram ceftriaxone injection recon soln 0 gram ceftriaxone injection recon soln 250 mg, 500 mg ceftriaxone intravenous cefuroxime axetil cefuroxime sodium injection cefuroxime sodium intravenous cephalexin SUPRAX ORAL CAPSULE You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 0

12 Name SUPRAX ORAL SUSPENSION FOR RECONSTITUTIO N 00 MG/5 ML, 200 MG/5 ML SUPRAX ORAL SUSPENSION FOR RECONSTITUTIO N 500 MG/5 ML SUPRAX ORAL TABLET SUPRAX ORAL TABLET,CHEWAB LE TEFLARO ERYTHROMYCINS / OTHER MACROLIDES azithromycin clarithromycin E.E.S. 400 E.E.S. GRANULES ERY-TAB ERYPED 200 ERYPED 400 ERYTHROCIN INTRAVENOUS RECON SOLN 500 MG ERYTHROCIN (AS STEARATE) erythromycin oral tablet erythromycin ethylsuccinate oral MISCELLANEOUS ANTIINFECTIVES You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. Name ALBENZA ALINIA amikacin injection solution 500 mg/2 ml atovaquone erythromycinsulfisoxazole atovaquoneproguanil aztreonam injection recon soln gram BACIIM bacitracin intramuscular BETHKIS B/D PA; MO; QL (224 per 28 days) CAPASTAT CAYSTON ; LA; QL (84 per 28 days) chloramphenicol sod succinate chloroquine phosphate oral clindamycin hcl clindamycin in dextrose 5 % CLINDAMYCIN PEDIATRIC clindamycin phosphate intravenous solution 600 mg/4 ml COARTEM colistin (colistimethate na) CUBICIN

13 Name dapsone DARAPRIM DORIBAX INTRAVENOUS SUSPENSION FOR RECONSTITUTIO N 500 MG ethambutol gentamicin injection solution 40 mg/ml gentamicin in nacl (iso-osm) intravenous piggyback 00 mg/00 ml, 60 mg/50 ml, 70 mg/50 ml, 80 mg/00 ml, 80 mg/50 ml, 90 mg/00 ml gentamicin sulfate (pf) intravenous solution 80 mg/8 ml hydroxychloroquine oral imipenem-cilastatin INVANZ INJECTION isoniazid injection isoniazid oral mefloquine meropenem intravenous recon soln 500 mg metronidazole oral capsule metronidazole oral tablet metronidazole in nacl (iso-os) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 2 Name NEBUPENT B/D PA; MO; QL (6 per 28 days) neomycin paromomycin PASER PENTAM polymyxin b sulfate PRIFTIN primaquine pyrazinamide quinine sulfate rifabutin rifampin SIRTURO ; LA streptomycin intramuscular STROMECTOL SYNERCID tinidazole tobramycin in % nacl tobramycin in 0.9 % nacl intravenous piggyback 80 mg/00 ml tobramycin sulfate injection solution B/D PA; MO; QL (280 per 28 days) TRECATOR TYGACIL XIFAXAN

14 Name ZYVOX INTRAVENOUS PARENTERAL SOLUTION 600 MG/300 ML ZYVOX ORAL PENICILLINS amoxicillin amoxicillin-pot clavulanate ampicillin ampicillin sodium injection recon soln gram, 0 gram, 25 mg ampicillin-sulbactam injection recon soln 5 gram ampicillin-sulbactam injection recon soln 3 gram AUGMENTIN ORAL SUSPENSION FOR RECONSTITUTIO N MG/5 ML BICILLIN C-R BICILLIN L-A dicloxacillin nafcillin injection recon soln gram, 0 gram nafcillin in dextrose iso-osm intravenous piggyback gram/50 ml You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 3 Name oxacillin injection recon soln 0 gram oxacillin intravenous recon soln 2 gram oxacillin in dextrose(iso-osm) penicillin g potassium injection recon soln 5 million unit penicillin g procaine intramuscular syringe.2 million unit/2 ml penicillin g sodium penicillin v potassium PFIZERPEN-G INJECTION RECON SOLN 5 MILLION UNIT piperacillintazobactam intravenous recon soln gram, 4.5 gram QUINOLONES AVELOX IN NACL (ISO-OSMOTIC) ciprofloxacin intravenous solution 400 mg/40 ml ciprofloxacin oral suspension,microcap sule recon ciprofloxacin oral tablet ciprofloxacin (mixture)

15 Name ciprofloxacin in 5 % dextrose intravenous piggyback 200 mg/00 ml levofloxacin intravenous levofloxacin oral levofloxacin in d5w intravenous piggyback 500 mg/00 ml moxifloxacin ofloxacin oral SULFA'S / RELATED AGENTS sulfadiazine oral sulfamethoxazoletrimethoprim TETRACYCLINES demeclocycline doxycycline hyclate intravenous doxycycline hyclate oral doxycycline monohydrate oral capsule 50 mg, 75 mg doxycycline monohydrate oral suspension for reconstitution doxycycline monohydrate oral tablet 50 mg, 50 mg, 75 mg minocycline oral tetracycline Name URINARY TRACT AGENTS MACRODANTIN ORAL CAPSULE 25 MG methenamine hippurate nitrofurantoin oral nitrofurantoin macrocrystal oral capsule 50 mg nitrofurantoin monohyd/m-cryst PRIMSOL trimethoprim VANCOMYCIN vancomycin intravenous recon soln,000 mg, 0 gram, 500 mg vancomycin oral ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS ADJUNCTIVE AGENTS amifostine crystalline dexrazoxane intravenous recon soln 250 mg ELITEK INTRAVENOUS RECON SOLN.5 MG FUSILEV KEPIVANCE You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 4

16 Name leucovorin calcium injection recon soln 00 mg, 350 mg leucovorin calcium oral mesna MESNEX ORAL XGEVA ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS ABRAXANE AFINITOR ORAL TABLET 0 MG AFINITOR ORAL TABLET 2.5 MG, 5 MG, 7.5 MG AFINITOR DISPERZ ALIMTA INTRAVENOUS RECON SOLN 500 MG PA; MO; QL (60 per 30 days) PA; MO PA; MO anastrozole ARRANON ARZERRA INTRAVENOUS SOLUTION 00 MG/5 ML B/D PA; MO AVASTIN azacitidine AZASAN B/D PA; MO azathioprine B/D PA; MO bicalutamide BICNU Name bleomycin injection recon soln 30 unit BOSULIF ORAL TABLET 00 MG BOSULIF ORAL TABLET 500 MG BUSULFEX CAPRELSA ORAL TABLET 00 MG CAPRELSA ORAL TABLET 300 MG carboplatin intravenous solution CELLCEPT ORAL SUSPENSION FOR RECONSTITUTIO N CELLCEPT INTRAVENOUS PA; MO PA; MO; QL (30 per 30 days) ; LA ; LA; QL (30 per 30 days) B/D PA; MO B/D PA cisplatin cladribine CLOLAR COMETRIQ PA; MO cyclophosphamide oral capsule cyclophosphamide oral tablet cyclosporine intravenous B/D PA B/D PA; MO B/D PA cyclosporine oral B/D PA; MO cyclosporine modified B/D PA; MO cytarabine You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 5

17 Name cytarabine (pf) injection solution 2 gram/20 ml (00 mg/ml) dacarbazine intravenous recon soln 200 mg daunorubicin intravenous solution decitabine DOCEFREZ docetaxel intravenous solution 80 mg/4 ml (20 mg/ml) docetaxel intravenous solution 80 mg/8 ml (0 mg/ml) DOXIL doxorubicin intravenous solution 50 mg/25 ml DROXIA ELIGARD PA; MO EMCYT epirubicin intravenous solution 50 mg/25 ml ERBITUX INTRAVENOUS SOLUTION 00 MG/50 ML ERIVEDGE PA; MO; QL (30 per 30 days) ERWINAZE ETOPOPHOS You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 6 Name etoposide intravenous exemestane FARESTON FASLODEX FIRMAGON KIT W DILUENT SYRINGE fludarabine intravenous recon soln fluorouracil intravenous solution 2.5 gram/50 ml flutamide FOLOTYN INTRAVENOUS SOLUTION 40 MG/2 ML (20 MG/ML) gemcitabine intravenous recon soln gram GENGRAF B/D PA; MO GILOTRIF ORAL TABLET 20 MG GILOTRIF ORAL TABLET 30 MG GILOTRIF ORAL TABLET 40 MG GLEEVEC ORAL TABLET 00 MG GLEEVEC ORAL TABLET 400 MG PA; MO; QL (60 per 30 days) PA; MO; QL (40 per 30 days) PA; MO; QL (30 per 30 days) PA; MO PA; MO; QL (60 per 30 days)

18 Name HALAVEN HERCEPTIN HEXALEN hydroxyurea idarubicin ifosfamide intravenous recon soln gram IMBRUVICA PA; MO; QL (20 per 30 days) INLYTA ORAL TABLET MG INLYTA ORAL TABLET 5 MG irinotecan intravenous solution 00 mg/5 ml PA; MO PA; MO; QL (20 per 30 days) ISTODAX IXEMPRA INTRAVENOUS RECON SOLN 45 MG JAKAFI ORAL TABLET 0 MG, 5 MG, 20 MG, 5 MG JAKAFI ORAL TABLET 25 MG PA; MO PA; MO; QL (60 per 30 days) JEVTANA KADCYLA INTRAVENOUS RECON SOLN 00 MG letrozole LEUKERAN Name leuprolide lomustine LUPRON DEPOT PA; MO LUPRON DEPOT (3 MONTH) LUPRON DEPOT (4 MONTH) LUPRON DEPOT (6 MONTH) LUPRON DEPOT- PED INTRAMUSCULA R KIT.25 MG, 5 MG PA; MO PA; MO PA; MO PA; MO LYSODREN MATULANE megestrol oral suspension 400 mg/0 ml (40 mg/ml) megestrol oral tablet MEKINIST ORAL TABLET 0.5 MG MEKINIST ORAL TABLET 2 MG melphalan PA; MO; QL (20 per 30 days) PA; MO; QL (30 per 30 days) mercaptopurine methotrexate sodium oral methotrexate sodium (pf) injection recon soln methotrexate sodium (pf) injection solution B/D PA; MO B/D PA B/D PA; MO You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 7

19 Name mitomycin intravenous recon soln 20 mg mitoxantrone MUSTARGEN mycophenolate mofetil mycophenolate sodium B/D PA; MO B/D PA; MO NEXAVAR PA; MO; LA NILANDRON NULOJIX B/D PA; MO octreotide acetate injection solution ONCASPAR oxaliplatin intravenous solution 00 mg/20 ml paclitaxel PERJETA POMALYST PROGRAF INTRAVENOUS RAPAMUNE ORAL SOLUTION RAPAMUNE ORAL TABLET MG, 2 MG B/D PA; MO B/D PA; MO B/D PA; MO REVLIMID PA; MO; LA RITUXAN PA; MO SANDOSTATIN LAR DEPOT SIGNIFOR PA; MO Name SIMULECT INTRAVENOUS RECON SOLN 20 MG B/D PA; MO sirolimus B/D PA; MO SOLTAMOX SPRYCEL ORAL TABLET 00 MG, 20 MG, 50 MG, 80 MG SPRYCEL ORAL TABLET 40 MG SPRYCEL ORAL TABLET 70 MG PA; MO PA; MO; QL (30 per 30 days) PA; MO; QL (60 per 30 days) STIVARGA PA; MO; QL (84 per 28 days) SUTENT ORAL CAPSULE 2.5 MG SUTENT ORAL CAPSULE 25 MG SUTENT ORAL CAPSULE 50 MG SYLVANT INTRAVENOUS RECON SOLN 00 MG PA; MO PA; MO; QL (60 per 30 days) PA; MO; QL (30 per 30 days) SYNRIBO TABLOID tacrolimus B/D PA; MO TAFINLAR ORAL CAPSULE 50 MG PA; MO; QL (80 per 30 days) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 8

20 Name TAFINLAR ORAL CAPSULE 75 MG PA; MO; QL (20 per 30 days) tamoxifen TARCEVA ORAL TABLET 00 MG, 25 MG TARCEVA ORAL TABLET 50 MG PA; MO PA; MO; QL (30 per 30 days) TARGRETIN TASIGNA ORAL CAPSULE 50 MG TASIGNA ORAL CAPSULE 200 MG PA; MO PA; MO; QL (2 per 28 days) THALOMID PA; MO TOPOSAR topotecan intravenous recon soln TORISEL TREANDA INTRAVENOUS RECON SOLN 00 MG TRELSTAR TRELSTAR DEPOT TRELSTAR LA tretinoin (chemotherapy) TRISENOX TYKERB PA; MO; LA; QL (80 per 30 days) Name VECTIBIX INTRAVENOUS SOLUTION 00 MG/5 ML (20 MG/ML) B/D PA; MO VELCADE vinblastine intravenous solution vincristine intravenous solution mg/ml vinorelbine intravenous solution 50 mg/5 ml VOTRIENT PA; MO; QL (20 per 30 days) XALKORI ORAL CAPSULE 200 MG XALKORI ORAL CAPSULE 250 MG PA; MO PA; MO; QL (60 per 30 days) XTANDI PA; MO; QL (20 per 30 days) YERVOY INTRAVENOUS SOLUTION 50 MG/0 ML (5 MG/ML) ZALTRAP INTRAVENOUS SOLUTION 00 MG/4 ML (25 MG/ML) ZANOSAR ZELBORAF PA; MO; QL (240 per 30 days) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 9

21 Name ZOLINZA ZORTRESS B/D PA; MO ZYKADIA PA; MO; QL (50 per 30 days) ZYTIGA PA; MO; QL (20 per 30 days) AUTONOMIC / CNS DRUGS, NEUROLOGY / PSYCH ANTICONVULSANTS APTIOM BANZEL carbamazepine CELONTIN clonazepam PA; MO diazepam rectal PA; MO DILANTIN divalproex EPITOL ethosuximide felbamate fosphenytoin injection solution 00 mg pe/2 ml FYCOMPA gabapentin oral capsule gabapentin oral solution 250 mg/5 ml gabapentin oral tablet Name GABITRIL ORAL TABLET 2 MG, 6 MG lamotrigine oral tablet lamotrigine oral tablet extended release 24hr lamotrigine oral tablet, chewable dispersible levetiracetam intravenous levetiracetam oral solution 00 mg/ml levetiracetam oral tablet levetiracetam oral tablet extended release 24 hr LYRICA PA; MO ONFI PA; MO oxcarbazepine PEGANONE phenobarbital phenytoin oral suspension 25 mg/5 ml phenytoin oral tablet,chewable phenytoin sodium intravenous solution phenytoin sodium extended POTIGA primidone You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 20

22 Name SABRIL ; LA TEGRETOL XR ORAL TABLET EXTENDED RELEASE 2 HR 00 MG tiagabine topiramate oral capsule, sprinkle topiramate oral tablet PA; MO PA; MO valproate sodium valproic acid valproic acid (as sodium salt) oral solution 250 mg/5 ml VIMPAT INTRAVENOUS VIMPAT ORAL zonisamide PA; MO ANTIPARKINSONISM AGENTS APOKYN ; LA AZILECT benztropine bromocriptine carbidopa carbidopa-levodopa carbidopa-levodopaentacapone entacapone NEUPRO pramipexole ropinirole selegiline hcl Name MIGRAINE / CLUSTER HEADACHE THERAPY dihydroergotamine injection ERGOMAR MIGERGOT naratriptan ; QL (8 per 28 days) rizatriptan ; QL (36 per 28 days) sumatriptan nasal spray,non-aerosol 20 mg/actuation sumatriptan nasal spray,non-aerosol 5 mg/actuation sumatriptan succinate oral sumatriptan succinate subcutaneous pen injector 6 mg/0.5 ml sumatriptan succinate subcutaneous solution ; QL (8 per 28 days) ; QL (36 per 28 days) ; QL (8 per 28 days) ; QL (6 per 28 days) ; QL (6 per 28 days) zolmitriptan ; QL (8 per 28 days) MISCELLANEOUS NEUROLOGICAL THERAPY AMPYRA PA; MO; LA COPAXONE SUBCUTANEOUS SYRINGE KIT PA; MO; QL (30 per 30 days) donepezil EXELON TRANSDERMAL ST; MO You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 2

23 Name galantamine GILENYA PA; MO NAMENDA PA; MO NAMENDA TITRATION PAK PA; MO NUEDEXTA rivastigmine tartrate TECFIDERA PA; MO TYSABRI PA; MO; LA XENAZINE PA; MO; LA MUSCLE RELAXANTS / ANTISPASMODIC THERAPY baclofen cyclobenzaprine PA; MO dantrolene GABLOFEN INTRATHECAL SOLUTION 0,000 MCG/20ML (500 MCG/ML), 40,000 MCG/20ML (2,000 MCG/ML) GABLOFEN INTRATHECAL SYRINGE 50 MCG/ML ( ML) LIORESAL INTRATHECAL SOLUTION 2,000 MCG/ML, 500 MCG/ML LIORESAL INTRATHECAL SOLUTION 50 MCG/ML MESTINON ORAL SYRUP B/D PA; MO B/D PA; MO B/D PA; MO B/D PA Name MESTINON TIMESPAN pyridostigmine bromide tizanidine NARCOTIC ANALGESICS acetaminophencodeine oral solution 300 mg-30 mg /2.5 ml acetaminophencodeine oral tablet mg, mg acetaminophencodeine oral tablet mg buprenorphine injection syringe buprenorphine sublingual tablet, sublingual 2 mg buprenorphine sublingual tablet, sublingual 8 mg codeine sulfate oral tablet DURAMORPH (PF) INJECTION SOLUTION 0.5 MG/ML DURAMORPH (PF) INJECTION SOLUTION MG/ML ENDOCET ORAL TABLET MG, MG, MG QL (4500 per 30 days) ; QL (360 ; QL (80 QL (267 per 30 days) ; QL (300 ; QL (75 ; QL (80 ; QL (4000 QL (2000 per 30 days) ; QL (360 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 22

24 Name ENDODAN ; QL (360 fentanyl citrate buccal lozenge on a handle,200 mcg fentanyl citrate buccal lozenge on a handle,600 mcg fentanyl citrate buccal lozenge on a handle 200 mcg fentanyl citrate buccal lozenge on a handle 400 mcg fentanyl citrate buccal lozenge on a handle 600 mcg fentanyl citrate buccal lozenge on a handle 800 mcg fentanyl patches transdermal patch 72 hour 00 mcg/hr fentanyl patches transdermal patch 72 hour 2 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr hydrocodoneacetaminophen oral solution mg/5 ml hydrocodoneacetaminophen oral tablet mg, mg, mg, mg, mg, mg PA; MO; QL (39 per 30 days) PA; MO; QL (29 per 30 days) PA; MO; QL (20 per 30 days) PA; MO; QL (6 per 30 days) PA; MO; QL (77 per 30 days) PA; MO; QL (58 per 30 days) ; QL (9 per 30 days) ; QL (0 ; QL (5550 ; QL (360 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 23 Name hydrocodoneibuprofen oral tablet mg hydromorphone oral liquid hydromorphone oral tablet hydromorphone oral tablet extended release 24 hr 2 mg, 6 mg, 8 mg hydromorphone (pf) injection solution 0 mg/ml ; QL (50 ; QL (300 ; QL (80 ; QL (60 ; QL (20 ibuprofen-oxycodone ; QL (28 levorphanol tartrate ; QL (20 LORCET (HYDROCODONE) QL (360 per 30 days) LORCET HD ; QL (360 LORCET PLUS QL (360 per 30 days) LORTAB ; QL (360 LORTAB ; QL (360 LORTAB ; QL (360 methadone injection QL (60 per 30 days) methadone oral solution 0 mg/5 ml methadone oral solution 5 mg/5 ml methadone oral tablet 0 mg ; QL (600 ; QL (200 ; QL (20

25 Name methadone oral tablet 5 mg morphine intravenous syringe 2 mg/ml morphine intravenous syringe 4 mg/ml morphine oral capsule, er multiphase 24 hr 20 mg morphine oral capsule, er multiphase 24 hr 30 mg, 45 mg, 60 mg, 75 mg, 90 mg morphine oral capsule,extend.relea se pellets 0 mg, 20 mg, 30 mg, 50 mg, 60 mg morphine oral capsule,extend.relea se pellets 00 mg morphine oral capsule,extend.relea se pellets 80 mg morphine oral solution ; QL (240 QL (000 per 30 days) QL (500 per 30 days) ; QL (50 ; QL (60 ; QL (90 ; QL (60 ; QL (75 ; QL (900 morphine oral tablet ; QL (80 morphine oral tablet extended release 00 mg morphine oral tablet extended release 5 mg, 30 mg ; QL (60 ; QL (20 Name morphine oral tablet extended release 200 mg morphine oral tablet extended release 60 mg morphine concentrate oral solution oxycodone oral capsule oxycodone oral concentrate oxycodone oral solution oxycodone oral tablet 0 mg, 5 mg, 20 mg oxycodone oral tablet 30 mg oxycodone oral tablet 5 mg oxycodoneacetaminophen ; QL (30 ; QL (00 ; QL (300 ; QL (360 ; QL (80 ; QL (200 ; QL (80 ; QL (34 ; QL (360 ; QL (360 oxycodone-aspirin ; QL (360 oxymorphone oral tablet 0 mg oxymorphone oral tablet 5 mg oxymorphone oral tablet extended release 2 hr 0 mg, 5 mg, 20 mg, 5 mg, 7.5 mg oxymorphone oral tablet extended release 2 hr 30 mg ; QL (200 ; QL (80 ; QL (90 ; QL (67 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 24

26 Name oxymorphone oral tablet extended release 2 hr 40 mg ; QL (50 REPREXAIN ; QL (50 VICODIN ; QL (360 VICODIN ES ; QL (360 VICODIN HP ; QL (360 ZAMICET ; QL (5550 NON-NARCOTIC ANALGESICS butorphanol tartrate injection solution mg/ml butorphanol tartrate injection solution 2 mg/ml butorphanol tartrate nasal PA; MO; QL (90 per 30 days) ; QL (720 ; QL (360 ; QL (40 CELEBREX diclofenac potassium diclofenac sodium oral diclofenac sodium topical drops buprenorphinenaloxone diclofenacmisoprostol diflunisal etodolac fenoprofen oral tablet You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 25 Name flurbiprofen ibuprofen oral suspension ibuprofen oral tablet 400 mg, 600 mg, 800 mg ketoprofen meclofenamate oral mefenamic acid meloxicam oral suspension meloxicam oral tablet 5 mg meloxicam oral tablet 7.5 mg ; QL (30 nabumetone nalbuphine injection solution 0 mg/ml nalbuphine injection solution 20 mg/ml naloxone injection syringe mg/ml ; QL (200 ; QL (00 naltrexone naproxen naproxen sodium oral tablet 275 mg, 550 mg oxaprozin piroxicam sulindac oral tolmetin tramadol oral tablet ; QL (240

27 Name tramadol oral tablet extended release 24 hr 00 mg, 200 mg tramadol oral tablet, er multiphase 24 hr 300 mg tramadolacetaminophen ; QL (30 ; QL (30 ; QL (240 VOLTAREN GEL ST; MO ZUBSOLV PA; MO; QL (90 per 30 days) PSYCHOTHERAPEUTIC DRUGS ABILIFY INTRAMUSCULA R ABILIFY ORAL SOLUTION ABILIFY ORAL TABLET 0 MG ABILIFY ORAL TABLET 5 MG, 20 MG ABILIFY ORAL TABLET 2 MG ABILIFY ORAL TABLET 30 MG ABILIFY ORAL TABLET 5 MG ABILIFY DISCMELT ORAL TABLET,DISINTE GRATING 0 MG ABILIFY DISCMELT ORAL TABLET,DISINTE GRATING 5 MG ; QL (90 ; QL (60 ; QL (450 ; QL (30 ; QL (80 ; QL (90 ; QL (60 Name ABILIFY MAINTENA INTRAMUSCULA R SUSPENSION,EXT ENDED REL RECON 300 MG alprazolam oral tablet amitriptyline PA; MO amoxapine AMPHETAMINE SALT COMBO BRINTELLIX ORAL TABLET 0 MG BRINTELLIX ORAL TABLET 20 MG BRINTELLIX ORAL TABLET 5 MG bupropion hcl oral tablet bupropion hcl oral tablet extended release 00 mg bupropion hcl oral tablet extended release 50 mg bupropion hcl oral tablet extended release 200 mg bupropion hcl oral tablet extended release 24 hr 50 mg bupropion hcl oral tablet extended release 24 hr 300 mg ; QL (60 ; QL (30 ; QL (20 ; QL (20 ; QL (90 ; QL (60 ; QL (90 ; QL (60 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 26

28 Name buspirone chlorpromazine citalopram oral solution citalopram oral tablet 0 mg citalopram oral tablet 20 mg citalopram oral tablet 40 mg ; QL (20 ; QL (60 ; QL (30 clomipramine PA; MO clonidine hcl oral tablet extended release 2 hr clorazepate dipotassium clozapine oral tablet PA; MO desipramine oral dexmethylphenidate dextroamphetamine oral capsule, extended release dextroamphetamine oral tablet dextroamphetamineamphetamine diazepam oral solution 5 mg/5 ml PA; MO diazepam oral tablet PA; MO DIAZEPAM INTENSOL PA; MO doxepin oral PA; MO duloxetine oral capsule,delayed release(dr/ec) 20 mg ; QL (80 Name duloxetine oral capsule,delayed release(dr/ec) 30 mg duloxetine oral capsule,delayed release(dr/ec) 60 mg ; QL (20 ; QL (60 EMSAM ergoloid escitalopram oxalate oral solution escitalopram oxalate oral tablet 0 mg escitalopram oxalate oral tablet 20 mg escitalopram oxalate oral tablet 5 mg ; QL (60 ; QL (30 ; QL (20 eszopiclone ST; MO; QL (30 per 30 days) FANAPT ORAL TABLET MG FANAPT ORAL TABLET 0 MG, 8 MG FANAPT ORAL TABLET 2 MG FANAPT ORAL TABLET 2 MG FANAPT ORAL TABLET 4 MG FANAPT ORAL TABLET 6 MG FANAPT ORAL TABLETS,DOSE PACK ; QL (720 ; QL (90 ; QL (60 ; QL (360 ; QL (80 ; QL (20 QL (8 per 28 days) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 27

29 Name FAZACLO ORAL TABLET,DISINTE GRATING 50 MG, 200 MG FETZIMA ORAL CAPSULE,EXT REL 24HR DOSE PACK FETZIMA ORAL CAPSULE,EXTEN DED RELEASE 24 HR 20 MG FETZIMA ORAL CAPSULE,EXTEN DED RELEASE 24 HR 20 MG FETZIMA ORAL CAPSULE,EXTEN DED RELEASE 24 HR 40 MG FETZIMA ORAL CAPSULE,EXTEN DED RELEASE 24 HR 80 MG fluoxetine oral capsule 0 mg fluoxetine oral capsule 20 mg fluoxetine oral capsule 40 mg fluoxetine oral capsule,delayed release(dr/ec) fluoxetine oral solution fluoxetine oral tablet 0 mg fluoxetine oral tablet 20 mg ST; MO; QL (28 per 28 days) ST; MO; QL (30 per 30 days) ST; MO; QL (80 per 30 days) ST; MO; QL (90 per 30 days) ST; MO; QL (45 per 30 days) ; QL (240 ; QL (60 ; QL (4 per 28 days) ; QL (240 Name fluphenazine decanoate fluphenazine hcl fluvoxamine oral capsule,extended release 24hr 00 mg fluvoxamine oral capsule,extended release 24hr 50 mg fluvoxamine oral tablet 00 mg fluvoxamine oral tablet 25 mg fluvoxamine oral tablet 50 mg GEODON INTRAMUSCULA R ; QL (90 ; QL (60 ; QL (90 ; QL (360 ; QL (80 guanidine haloperidol haloperidol decanoate haloperidol lactate imipramine hcl PA; MO imipramine pamoate PA; MO INVEGA ORAL TABLET EXTENDED RELEASE 24HR.5 MG INVEGA ORAL TABLET EXTENDED RELEASE 24HR 3 MG ; QL (240 ; QL (20 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 28

30 Name INVEGA ORAL TABLET EXTENDED RELEASE 24HR 6 MG INVEGA ORAL TABLET EXTENDED RELEASE 24HR 9 MG INVEGA SUSTENNA LATUDA ORAL TABLET 20 MG LATUDA ORAL TABLET 20 MG LATUDA ORAL TABLET 40 MG LATUDA ORAL TABLET 60 MG, 80 MG ; QL (60 ; QL (4 ; QL (30 ; QL (240 ; QL (20 ; QL (60 lithium carbonate lithium citrate lorazepam oral tablet LORAZEPAM INTENSOL PA; MO PA; MO loxapine succinate maprotiline MARPLAN METADATE ER methamphetamine methylphenidate oral capsule, er biphasic mg, 50 mg, 60 mg Name methylphenidate oral capsule,er biphasic methylphenidate oral solution methylphenidate oral tablet methylphenidate oral tablet extended release methylphenidate oral tablet extended release 24hr mirtazapine modafinil PA; MO nefazodone nortriptyline olanzapine intramuscular olanzapine oral tablet 0 mg olanzapine oral tablet 5 mg, 20 mg olanzapine oral tablet 2.5 mg olanzapine oral tablet 5 mg olanzapine oral tablet 7.5 mg olanzapine oral tablet,disintegrating 0 mg olanzapine oral tablet,disintegrating 5 mg, 20 mg ; QL (60 ; QL (30 ; QL (240 ; QL (20 ; QL (8 ; QL (60 ; QL (30 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 29

31 Name olanzapine oral tablet,disintegrating 5 mg ; QL (20 ORAP oxazepam PA; MO paroxetine hcl oral tablet 0 mg paroxetine hcl oral tablet 20 mg paroxetine hcl oral tablet 30 mg paroxetine hcl oral tablet 40 mg paroxetine hcl oral tablet extended release 24 hr 2.5 mg paroxetine hcl oral tablet extended release 24 hr 25 mg paroxetine hcl oral tablet extended release 24 hr 37.5 mg PAXIL ORAL SUSPENSION ; QL (80 ; QL (90 ; QL (60 ; QL (45 ; QL (80 ; QL (90 ; QL (60 perphenazine olanzapinefluoxetine perphenazineamitriptyline PA; MO phenelzine PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 00 MG ST; MO; QL (20 per 30 days) Name PRISTIQ ORAL TABLET EXTENDED RELEASE 24 HR 50 MG ST; MO; QL (240 per 30 days) PROCENTRA protriptyline quetiapine oral tablet 00 mg quetiapine oral tablet 200 mg quetiapine oral tablet 25 mg quetiapine oral tablet 300 mg quetiapine oral tablet 400 mg quetiapine oral tablet 50 mg RISPERDAL CONSTA risperidone oral solution risperidone oral tablet 0.25 mg risperidone oral tablet 0.5 mg risperidone oral tablet mg risperidone oral tablet 2 mg risperidone oral tablet 3 mg risperidone oral tablet 4 mg ; QL (240 ; QL (20 ; QL (902 ; QL (8 ; QL (60 ; QL (480 ; QL (480 ; QL (920 ; QL (960 ; QL (480 ; QL (240 ; QL (6 ; QL (20 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 30

32 Name risperidone oral tablet,disintegrating 0.25 mg risperidone oral tablet,disintegrating 0.5 mg risperidone oral tablet,disintegrating mg risperidone oral tablet,disintegrating 2 mg risperidone oral tablet,disintegrating 3 mg risperidone oral tablet,disintegrating 4 mg ; QL (920 ; QL (960 ; QL (480 ; QL (240 ; QL (6 ; QL (20 ROZEREM ; QL (30 SAPHRIS SUBLINGUAL TABLET, SUBLINGUAL 0 MG SAPHRIS SUBLINGUAL TABLET, SUBLINGUAL 5 MG SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET, SUBLINGUAL 0 MG ; QL (60 ; QL (20 ; QL (60 Name SAPHRIS (BLACK CHERRY) SUBLINGUAL TABLET, SUBLINGUAL 5 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 50 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 200 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 300 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 400 MG SEROQUEL XR ORAL TABLET EXTENDED RELEASE 24 HR 50 MG sertraline oral concentrate sertraline oral tablet 00 mg sertraline oral tablet 25 mg sertraline oral tablet 50 mg ; QL (20 ; QL (6 ; QL (20 ; QL (8 ; QL (60 ; QL (480 ; QL (60 ; QL (240 ; QL (20 STRATTERA You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 3

33 Name SURMONTIL PA; MO temazepam PA; MO thioridazine thiothixene tranylcypromine trazodone trifluoperazine venlafaxine oral capsule,extended release 24hr 50 mg venlafaxine oral capsule,extended release 24hr 37.5 mg venlafaxine oral capsule,extended release 24hr 75 mg venlafaxine oral tablet 00 mg, 75 mg venlafaxine oral tablet 25 mg venlafaxine oral tablet 37.5 mg venlafaxine oral tablet 50 mg ; QL (60 ; QL (80 ; QL (90 ; QL (90 VERSACLOZ LA VIIBRYD ORAL TABLET 0 MG VIIBRYD ORAL TABLET 20 MG VIIBRYD ORAL TABLET 40 MG VIIBRYD ORAL TABLETS,DOSE PACK ; QL (270 ; QL (80 ; QL (50 ; QL (20 ; QL (60 ; QL (30 ; QL (30 XYREM ; LA Name zaleplon oral capsule 0 mg zaleplon oral capsule 5 mg ZENZEDI ORAL TABLET 0 MG, 5 MG ziprasidone hcl oral capsule 20 mg ziprasidone hcl oral capsule 40 mg ziprasidone hcl oral capsule 60 mg ziprasidone hcl oral capsule 80 mg ST; MO; QL (60 per 30 days) ST; MO; QL (30 per 30 days) ; QL (240 ; QL (20 ; QL (80 ; QL (60 zolpidem ST; MO; QL (30 per 30 days) CARDIOVASCULAR, HYPERTENSION / LIPIDS ANTIARRHYTHMIC AGENTS amiodarone intravenous solution amiodarone oral tablet 200 mg, 400 mg B/D PA; MO flecainide mexiletine PACERONE procainamide injection solution 00 mg/ml procainamide injection solution 500 mg/ml You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 32

34 Name propafenone quinidine gluconate quinidine sulfate SORINE ORAL TABLET 20 MG, 60 MG, 80 MG SORINE ORAL TABLET 240 MG sotalol oral tablet 60 mg, 240 mg, 80 mg SOTALOL AF ORAL TABLET 20 MG TIKOSYN ANTIHYPERTENSIVE THERAPY acebutolol oral AFEDITAB CR amiloride amlodipine atenolol benazepril betaxolol oral bisoprolol fumarate bumetanide You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 33 Name candesartan captopril amiloridehydrochlorothiazide amlodipinebenazepril atenololchlorthalidone benazeprilhydrochlorothiazide bisoprololhydrochlorothiazide candesartanhydrochlorothiazid captoprilhydrochlorothiazide CARTIA XT carvedilol chlorothiazide chlorothiazide sodium chlorthalidone clonidine ; QL (4 per 28 days) clonidine hcl oral tablet CLORPRES ORAL TABLET 0.-5 MG, MG DEMSER DIBENZYLINE DILT-XR diltiazem hcl intravenous diltiazem hcl oral capsule, extended release 80 mg, 360 mg, 420 mg diltiazem hcl oral capsule,extended release 2 hr diltiazem hcl oral capsule,extended release 24hr 20 mg, 240 mg, 300 mg

35 Name diltiazem hcl oral tablet doxazosin oral tablet mg, 2 mg, 4 mg doxazosin oral tablet 8 mg ; QL (30 ; QL (60 DUTOPROL enalapril maleate eplerenone eprosartan felodipine fosinopril furosemide injection solution furosemide oral hydralazine hydrochlorothiazide indapamide irbesartan isradipine labetalol intravenous solution labetalol oral lisinopril losartan Name enalaprilhydrochlorothiazide fosinoprilhydrochlorothiazide irbesartanhydrochlorothiazide lisinoprilhydrochlorothiazide losartanhydrochlorothiazide MATZIM LA methyclothiazide methyldopa metolazone metoprolol succinate metoprolol tartrate intravenous solution metoprolol tartrate oral minoxidil oral moexipril nadolol metoprolol tahydrochlorothiaz moexiprilhydrochlorothiazide nadololbendroflumethiazide nicardipine NIFEDICAL XL nifedipine oral tablet extended release 24hr nimodipine nisoldipine perindopril erbumine pindolol prazosin propranolol intravenous propranolol oral You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 34

36 Name quinapril ramipril REMODULIN PA; MO; LA spironolactone TAZTIA XT telmisartan terazosin oral capsule mg, 2 mg, 5 mg terazosin oral capsule 0 mg ; QL (30 ; QL (60 timolol maleate oral torsemide intravenous solution 20 mg/2 ml (0 mg/ml) torsemide oral trandolapril propranololhydrochlorothiazid quinaprilhydrochlorothiazide spironolactonhydrochlorothiaz telmisartanamlodipine telmisartanhydrochlorothiazid triamterenehydrochlorothiazid valsartanhydrochlorothiazide verapamil intravenous solution verapamil oral Name CARDIAC GLYCOSIDES digoxin oral LANOXIN ORAL TABLET 87.5 MCG LANOXIN ORAL TABLET 62.5 MCG COAGULATION THERAPY AGGRENOX BRILINTA cilostazol clopidogrel dipyridamole oral EFFIENT ELIQUIS enoxaparin fondaparinux heparin (porcine) injection solution heparin (porcine) in 5 % dex intravenous parenteral solution 20,000 unit/500 ml (40 unit/ml), 25,000 unit/250 ml(00 unit/ml) heparin (porcine) in 5 % dex intravenous parenteral solution 25,000 unit/500 ml (50 unit/ml) heparin (porcine) in nacl (pf) intravenous parenteral solution,000 unit/500 ml JANTOVEN You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 35

37 Name pentoxifylline PROMACTA PA; MO; LA tranexamic acid intravenous warfarin XARELTO LIPID/CHOLESTEROL LOWERING AGENTS ADVICOR ORAL TABLET, ER MULTIPHASE 24 HR, MG, MG ADVICOR ORAL TABLET, ER MULTIPHASE 24 HR, MG, MG amlodipineatorvastatin ; QL (60 ; QL (30 ; QL (30 atorvastatin ; QL (30 CHOLESTYRAMI NE LIGHT ORAL POWDER IN PACKET colestipol oral granules colestipol oral tablet fenofibrate oral tablet fenofibrate micronized fenofibrate nanocrystallized fenofibric acid (choline) Name fluvastatin oral capsule 20 mg fluvastatin oral capsule 40 mg ; QL (30 ; QL (60 gemfibrozil oral JUXTAPID ; LA KYNAMRO ; LA lovastatin oral tablet 0 mg lovastatin oral tablet 20 mg, 40 mg niacin oral tablet extended release 24 hr omega-3 acid ethyl esters ; QL (30 ; QL (60 pravastatin ; QL (30 PREVALITE ORAL POWDER simvastatin ; QL (30 WELCHOL ZETIA MISCELLANEOUS CARDIOVASCULAR AGENTS RANEXA VECAMYL NITRATES isosorbide dinitrate isosorbide mononitrate NITRO-BID nitroglycerin intravenous B/D PA You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 36

38 Name nitroglycerin transdermal nitroglycerin translingual spray,non-aerosol NITROSTAT DERMATOLOGICALS/TOPICAL THERAPY ANTIPSORIATIC / ANTISEBORRHEIC acitretin calcipotriene calcitriol topical selenium sulfide topical suspension BURN THERAPY silver sulfadiazine SSD MISCELLANEOUS DERMATOLOGICALS 8-MOP ammonium lactate CARAC diclofenac sodium topical gel fluorouracil topical imiquimod methoxsalen rapid OXSORALEN PANRETIN podofilox PROTOPIC PA; MO Name PRUDOXIN REGRANEX ; QL (5 UVADEX ZYCLARA THERAPY FOR ACNE adapalene PA; MO AMNESTEEM AVITA TOPICAL CREAM PA; MO CLARAVIS clindamycin phosphate topical clindamycin-benzoyl peroxide topical gel ERY PADS erythromycin with ethanol topical gel erythromycin with ethanol topical solution calcipotrienebetamethasone erythromycinbenzoyl peroxide metronidazole topical cream metronidazole topical gel metronidazole topical lotion MYORISAN TAZORAC PA; MO tretinoin topical PA; MO ZENATANE TOPICAL ANESTHETICS You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 37

39 Name lidocaine topical adhesive patch,medicated lidocaine topical ointment lidocaine (pf) injection solution 0 mg/ml ( %), 5 mg/ml (0.5 %) lidocaine hcl injection solution 20 mg/ml (2 %) lidocaine hcl mucous membrane gel lidocaine hcl mucous membrane jelly in applicator lidocaine hcl mucous membrane solution 2 % lidocaine hcl mucous membrane solution 4 % lidocaine-prilocaine topical cream PA; MO TOPICAL ANTIBACTERIALS gentamicin topical mafenide acetate mupirocin mupirocin calcium sulfacetamide sodium (acne) SULFAMYLON TOPICAL CREAM TOPICAL ANTIFUNGALS ciclopirox clotrimazole topical You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 38 Name econazole topical ketoconazole topical KETODAN KIT NYAMYC nystatin topical clotrimazolebetamethasone nystatintriamcinolone NYSTOP PEDI-DRI TOPICAL ANTIVIRALS acyclovir topical DENAVIR ZOVIRAX TOPICAL CREAM TOPICAL CORTICOSTEROIDS ALA-CORT alclometasone amcinonide APEXICON E betamethasone dipropionate betamethasone valerate betamethasone, augmented clobetasol topical foam clobetasol topical gel clobetasol topical lotion

40 Name clobetasol topical ointment clobetasol topical shampoo clobetasol topical solution clobetasol-emollient topical cream desonide desoximetasone diflorasone fluocinolone fluocinonide topical cream 0. % fluocinonide topical gel fluocinonide topical ointment fluocinonide topical solution FLUOCINONIDE-E fluticasone topical halobetasol propionate hydrocortisone topical cream %, 2.5 % hydrocortisone topical lotion 2.5 % hydrocortisone topical ointment %, 2.5 % hydrocortisone butyr-emollient Name hydrocortisone butyrate topical ointment hydrocortisone butyrate topical solution hydrocortisone valerate mometasone prednicarbate triamcinolone acetonide topical TRIDERM TOPICAL ENZYMES SANTYL TOPICAL SCABICIDES / PEDICULICIDES lindane malathion permethrin topical cream spinosad DIAGNOSTICS / MISCELLANEOUS AGENTS IRRIGATING SOLUTIONS lactated ringers irrigation neomycin-polymyxin b gu ringers irrigation MISCELLANEOUS AGENTS acamprosate ADAGEN You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 39

41 Name alendronate oral tablet 40 mg ; QL (30 anagrelide ARALAST NP INTRAVENOUS RECON SOLN 500 MG ; LA CARBAGLU ; LA cevimeline CHEMET CLINIMIX 4.25%/D5W SULFIT FREE CLINIMIX E 2.75%/D0W SUL FREE CLINIMIX E 2.75%/D5W SULF FREE d0 % & 0.45 % sodium chloride d2.5 %-0.45 % sodium chloride d5 % and 0.9 % sodium chloride d5 %-0.45 % sodium chloride dextrose 0 % & 0.2 % nacl dextrose 0 % in water (d0w) dextrose 5 % in water (d5w) intravenous parenteral solution dextrose 5 %- lactated ringers B/D PA Name dextrose 5%-0.2 % sod chloride dextrose 5%-0.3 % sod.chloride disulfiram etidronate disodium EXJADE ; LA FERRIPROX INCRELEX ; LA KIONEX ORAL POWDER levocarnitine intravenous levocarnitine oral tablet levocarnitine (with sugar) midodrine ORFADIN ; LA pilocarpine hcl oral PROLASTIN-C ; LA RAVICTI RENVELA ORAL TABLET riluzole sodium chloride irrigation sodium chloride 0.9 % intravenous parenteral solution sodium phenylbutyrate SODIUM POLYSTYRENE (SORB FREE) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 40

42 Name SYPRINE THIOLA water for irrigation, sterile zoledronic acidmannitol-water intravenous solution SMOKING DETERRENTS PA; MO BUPROBAN CHANTIX CHANTIX CONTINUING MONTH BOX CHANTIX CONTINUING MONTH PAK CHANTIX STARTING MONTH BOX CHANTIX STARTING MONTH PAK NICOTROL NICOTROL NS EAR, NOSE / THROAT MEDICATIONS MISCELLANEOUS AGENTS azelastine nasal ; QL (60 chlorhexidine gluconate mucous membrane ipratropium bromide nasal ; QL (30 PERIOGARD Name triamcinolone acetonide dental TYZINE NASAL DROPS 0.05 % MISCELLANEOUS OTIC PREPARATIONS ACETASOL HC acetic acid otic fluocinolone acetonide oil hydrocortisoneacetic acid ofloxacin otic OTIC STEROID / ANTIBIOTIC CIPRODEX neomycinpolymyxin-hc otic ENDOCRINE/DIABETES ADRENAL HORMONES A-HYDROCORT cortisone dexamethasone oral elixir dexamethasone oral tablet DEXAMETHASON E INTENSOL dexamethasone sodium phosphate injection fludrocortisone hydrocortisone oral methylprednisolone oral tablet B/D PA; MO You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 4

43 Name methylprednisolone oral tablets,dose pack methylprednisolone acetate methylprednisolone sodium succ injection recon soln 25 mg methylprednisolone sodium succ injection recon soln 40 mg MILLIPRED ORAL TABLET prednisolone sodium phosphate oral solution 5 mg/5 ml, 5 mg base/5 ml (6.7 mg/5 ml) prednisolone sodium phosphate oral solution 25 mg/5 ml (5 mg/ml) prednisone oral solution prednisone oral tablet PREDNISONE INTENSOL triamcinolone acetonide injection suspension 0 mg/ml triamcinolone acetonide injection suspension 40 mg/ml B/D PA; MO B/D PA; MO VERIPRED 20 ANTITHYROID AGENTS methimazole You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 42 Name propylthiouracil DIABETES THERAPY acarbose oral tablet 00 mg acarbose oral tablet 25 mg acarbose oral tablet 50 mg ALCOHOL PADS BYDUREON SUBCUTANEOUS SUSPENSION,EXT ENDED REL RECON BYETTA SUBCUTANEOUS PEN INJECTOR 0 MCG/DOSE(250 MCG/ML) 2.4 ML BYETTA SUBCUTANEOUS PEN INJECTOR 5 MCG/DOSE (250 MCG/ML).2 ML ; QL (90 ; QL (360 ; QL (80 PA; MO; QL (4 per 28 days) PA; MO; QL (2.4 per 30 days) PA; MO; QL (.2 per 30 days) CYCLOSET ; QL (80 gauze pads 2 x 2 glimepiride oral tablet mg glimepiride oral tablet 2 mg glimepiride oral tablet 4 mg glipizide oral tablet 0 mg glipizide oral tablet 5 mg ; QL (240 ; QL (20 ; QL (60 ; QL (20 ; QL (240

44 Name glipizide oral tablet extended release 24hr 0 mg glipizide oral tablet extended release 24hr 2.5 mg glipizide oral tablet extended release 24hr 5 mg glipizide-metformin oral tablet mg glipizide-metformin oral tablet mg, mg GLUCAGEN GLUCAGEN HYPOKIT GLUCAGON EMERGENCY ; QL (60 ; QL (240 ; QL (20 ; QL (240 ; QL (20 HUMALOG HUMALOG KWIKPEN HUMALOG MIX HUMALOG MIX KWIKPEN HUMALOG MIX HUMALOG MIX KWIKPEN HUMULIN 70/30 HUMULIN 70/30 KWIKPEN HUMULIN 70/30 PEN HUMULIN N Name HUMULIN N KWIKPEN HUMULIN N PEN HUMULIN R HUMULIN R U-500 "CONCENTRATED " insulin pen needle insulin syringe (disp) u ml insulin syringe (disp) u-00 ml insulin syringe (disp) u-00 /2 ml INVOKANA ; QL (30 JANUMET ; QL (60 JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 00-,000 MG, MG JANUMET XR ORAL TABLET, ER MULTIPHASE 24 HR 50-,000 MG ; QL (30 ; QL (60 JANUVIA ; QL (30 JENTADUETO ; QL (60 LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR FLEXPEN You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 43

45 Name LEVEMIR FLEXTOUCH metformin oral tablet,000 mg metformin oral tablet 500 mg metformin oral tablet 850 mg metformin oral tablet extended release 24 hr 500 mg metformin oral tablet extended release 24 hr 750 mg metformin oral tablet extended release 24hr,000 mg nateglinide oral tablet 20 mg nateglinide oral tablet 60 mg needles, insulin disp.,safety ; QL (75 ; QL (50 ; QL (90 ; QL (20 ; QL (75 ; QL (75 ; QL (90 ; QL (80 NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX NOVOLOG MIX FLEXPEN NOVOLOG PENFILL pioglitazone ; QL (30 ; QL (30 Name pioglitazoneglimepiride pioglitazonemetformin ; QL (90 PROGLYCEM repaglinide oral tablet 0.5 mg repaglinide oral tablet mg repaglinide oral tablet 2 mg ; QL (960 ; QL (480 ; QL (240 RIOMET ; QL (765 SYMLINPEN 20 PA; MO; QL (8.9 per 30 days) SYMLINPEN 60 PA; MO; QL (0.5 per 30 days) tolazamide oral tablet 250 mg tolazamide oral tablet 500 mg ; QL (20 ; QL (60 tolbutamide ; QL (80 TRADJENTA ; QL (30 VGO 20 VGO 30 VGO 40 MISCELLANEOUS HORMONES ALDURAZYME ANADROL-50 PA; MO ANDROGEL PA; MO ANDROXY cabergoline ; QL (6 per 28 days) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 44

46 Name calcitonin (salmon) calcitriol intravenous calcitriol oral CEREZYME chorionic gonadotropin, human PA; MO danazol oral desmopressin injection desmopressin nasal spray,non-aerosol desmopressin oral doxercalciferol intravenous doxercalciferol oral ELAPRASE ELELYSO FABRAZYME INTRAVENOUS RECON SOLN 35 MG FORTICAL KUVAN ORAL TABLET,SOLUBL E ; LA LUMIZYME ; LA METHITEST MIACALCIN INJECTION MYALEPT PA; MO; LA MYOZYME NAGLAZYME ; LA NOVAREL PA; MO Name oxandrolone PA; MO pamidronate intravenous solution paricalcitol SAMSCA ORAL TABLET 5 MG SAMSCA ORAL TABLET 30 MG PA; MO; QL (30 per 30 days) PA; MO; QL (60 per 30 days) SENSIPAR SOMAVERT ; LA SYNAREL testosterone cypionate testosterone enanthate VPRIV ZAVESCA ; LA ZEMPLAR INTRAVENOUS zoledronic acid intravenous solution THYROID HORMONES levothyroxine oral LEVOXYL liothyronine intravenous liothyronine oral THYROLAR- THYROLAR-/2 THYROLAR-/4 THYROLAR-2 THYROLAR-3 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 45

47 Name UNITHROID ORAL TABLET 00 MCG, 2 MCG, 25 MCG, 50 MCG, 75 MCG, 200 MCG, 25 MCG, 300 MCG, 50 MCG, 75 MCG, 88 MCG GASTROENTEROLOGY ANTIDIARRHEALS / ANTISPASMODICS atropine injection syringe dicyclomine diphenoxylateatropine glycopyrrolate loperamide oral capsule MISCELLANEOUS GASTROINTESTINAL AGENTS ALOXI ; QL (0 AMITIZA balsalazide budesonide oral CANASA CESAMET B/D PA; MO CHENODAL PA; MO; LA COLOCORT COMPRO CONSTULOSE CORTIFOAM CREON Name cromolyn oral CYSTADANE DIPENTUM dronabinol B/D PA; MO EMEND INTRAVENOUS EMEND ORAL B/D PA; MO ENULOSE GAVILYTE-C GAVILYTE-G GAVILYTE-N GENERLAC granisetron intravenous solution mg/ml ( ml) granisetron oral B/D PA; MO granisetron (pf) intravenous solution 00 mcg/ml GRANISOL B/D PA; MO hydrocortisone rectal lactulose oral solution 0 gram/5 ml LIALDA LINZESS LOTRONEX meclizine oral tablet mesalamine with cleansing wipe metoclopramide hcl injection solution You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 46

48 Name metoclopramide hcl oral ondansetron B/D PA; MO ondansetron hcl oral solution ondansetron hcl oral tablet 24 mg ondansetron hcl oral tablet 4 mg, 8 mg ondansetron hcl (pf) injection solution peg electrolytes oral recon soln gram B/D PA; MO B/D PA B/D PA; MO PENTASA polyethylene glycol 3350 oral powder prochlorperazine prochlorperazine edisylate injection solution 0 mg/2 ml (5 mg/ml) prochlorperazine maleate oral PROCTO-PAK PROCTOZONE-HC RECTIV RELISTOR REMICADE PA; MO SUCRAID sulfasalazine oral tablet SULFAZINE EC TRANSDERM- SCOP You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 47 Name TRILYTE WITH FLAVOR PACKETS UCERIS ursodiol VIOKACE ZENPEP ORAL CAPSULE,DELAY ED RELEASE(DR/EC) 0,000-34,000-55,000 UNIT, 5,000-5,000-82,000 UNIT, 20,000-68,000-09,000 UNIT, 25,000-85,000-36,000 UNIT, 3,000-0,000-6,000 UNIT ULCER THERAPY amoxicilclarithromylansopraz CARAFATE ORAL SUSPENSION ; QL (2 cimetidine esomeprazole sodium famotidine oral suspension famotidine oral tablet 20 mg, 40 mg famotidine (pf) famotidine (pf)-nacl (iso-os) lansoprazole oral capsule,delayed release(dr/ec) 5 mg ; QL (30

49 Name lansoprazole oral capsule,delayed release(dr/ec) 30 mg misoprostol nizatidine omeprazole oral capsule,delayed release(dr/ec) 0 mg, 20 mg omeprazole oral capsule,delayed release(dr/ec) 40 mg omeprazole-sodium bicarbonate oral capsule 20-. mggram omeprazole-sodium bicarbonate oral capsule 40-. mggram pantoprazole intravenous pantoprazole oral tablet,delayed release (dr/ec) 20 mg pantoprazole oral tablet,delayed release (dr/ec) 40 mg ; QL (30 ; QL (30 ; QL (30 rabeprazole ranitidine hcl injection solution 25 mg/ml ranitidine hcl oral capsule ranitidine hcl oral syrup You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 48 Name ranitidine hcl oral tablet 50 mg, 300 mg sucralfate oral tablet IMMUNOLOGY, VACCINES / BIOTECHNOLOGY BIOTECHNOLOGY DRUGS ACTIMMUNE ARCALYST PA; MO AVONEX INTRAMUSCULA R KIT AVONEX INTRAMUSCULA R PEN INJECTOR KIT AVONEX INTRAMUSCULA R SYRINGE AVONEX ADMINISTRATIO N PACK BETASERON SUBCUTANEOUS KIT PA; MO; QL (4 per 28 days) PA; MO; QL (4 per 28 days) PA; MO; QL (4 per 28 days) PA; MO; QL (4 per 28 days) PA; MO; QL (5 per 28 days) EGRIFTA PA; MO ILARIS (PF) PA; MO; LA INTRON A INJECTION RECON SOLN 0 MILLION UNIT ( ML) INTRON A INJECTION SOLUTION 6 MILLION UNIT/ML LEUKINE

50 Name MOZOBIL NEULASTA PA; MO; QL (2 NEUMEGA NEUPOGEN INJECTION SOLUTION 480 MCG/.6 ML NEUPOGEN INJECTION SYRINGE PA; MO PA; MO OMNITROPE PA; MO PEGASYS ; QL (4 per 28 days) PEGASYS CONVENIENCE PACK PEGASYS PROCLICK ; QL (4 per 28 days) ; QL (4 per 28 days) PEGINTRON ; QL (4 per 28 days) PEGINTRON REDIPEN ; QL (4 per 28 days) PROCRIT PA; MO PROLEUKIN REBIF (WITH ALBUMIN) REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 22 MCG/0.5 ML, 44 MCG/0.5 ML REBIF REBIDOSE SUBCUTANEOUS PEN INJECTOR 8.8MCG/0.2ML-22 MCG/0.5ML (6) PA; MO; QL (6 per 28 days) PA; MO; QL (6 per 28 days) PA; MO; QL (2 per 28 days) Name REBIF TITRATION PACK PA; MO; QL (2 per 28 days) SAIZEN PA; MO SAIZEN CLICK.EASY PA; MO SYLATRON VACCINES / MISCELLANEOUS IMMUNOLOGICALS ACTHIB (PF) ADACEL(TDAP ADOLESN/ADULT )(PF) INTRAMUSCULA R SUSPENSION ATGAM B/D PA bcg vaccine, live (pf) BOOSTRIX TDAP BOTOX INJECTION RECON SOLN 00 UNIT CARIMUNE NF NANOFILTERED INTRAVENOUS RECON SOLN 3 GRAM CERVARIX VACCINE (PF) PA; MO PA COMVAX (PF) DAPTACEL (DTAP PEDIATRIC) (PF) ENGERIX-B (PF) INTRAMUSCULA R SYRINGE B/D PA; MO You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 49

51 Name ENGERIX-B PEDIATRIC (PF) INTRAMUSCULA R SUSPENSION ENGERIX-B PEDIATRIC (PF) INTRAMUSCULA R SYRINGE B/D PA; MO B/D PA fomepizole GAMASTAN S/D GAMUNEX-C INJECTION SOLUTION GRAM/0 ML (0 %) GARDASIL (PF) INTRAMUSCULA R SUSPENSION HAVRIX (PF) INTRAMUSCULA R SUSPENSION,440 ELISA UNIT/ML HAVRIX (PF) INTRAMUSCULA R SYRINGE 720 ELISA UNIT/0.5 ML IMOVAX RABIES VACCINE (PF) INFANRIX (DTAP) (PF) INTRAMUSCULA R SUSPENSION IPOL INJECTION SUSPENSION PA; MO IXIARO (PF) M-M-R II (PF) MENACTRA (PF) Name MENOMUNE - A/C/Y/W-35 (PF) MENVEO A-C-Y- W-35-DIP (PF) PEDVAX HIB (PF) PRIVIGEN PA; MO PROQUAD (PF) RABAVERT (PF) RAGWITEK RECOMBIVAX HB (PF) INTRAMUSCULA R SUSPENSION 0 MCG/ML, 40 MCG/ML ROTARIX ROTATEQ VACCINE tetanus toxoid,adsorbed (pf) tetanus-diphtheria toxoids-td TWINRIX (PF) INTRAMUSCULA R SUSPENSION TYPHIM VI INTRAMUSCULA R SOLUTION VAQTA (PF) INTRAMUSCULA R SUSPENSION 25 UNIT/0.5 ML B/D PA; MO VARIVAX (PF) YF-VAX (PF) ZOSTAVAX (PF) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 50

52 Name MUSCULOSKELETAL / RHEUMATOLOGY GOUT THERAPY allopurinol ALOPRIM colchicineprobenecid COLCRYS probenecid ULORIC ST; MO OSTEOPOROSIS THERAPY alendronate oral solution alendronate oral tablet 0 mg, 5 mg alendronate oral tablet 35 mg, 70 mg ; QL (286 ; QL (30 ; QL (4 per 28 days) FORTEO PA; MO; QL (2.4 per 28 days) ibandronate intravenous PA; MO ibandronate oral ; QL ( per 30 days) PROLIA PA; MO raloxifene risedronate ; QL ( per 30 days) OTHER RHEUMATOLOGICALS ACTEMRA PA; MO BENLYSTA INTRAVENOUS RECON SOLN 20 MG CUPRIMINE You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 5 Name DEPEN TITRATABS ENBREL SUBCUTANEOUS KIT ENBREL SUBCUTANEOUS SYRINGE 25 MG/0.5ML (0.5) ENBREL SUBCUTANEOUS SYRINGE 50 MG/ML (0.98 ML) ENBREL SURECLICK HUMIRA SUBCUTANEOUS KIT 20 MG/0.4 ML HUMIRA SUBCUTANEOUS KIT 40 MG/0.8 ML HUMIRA CROHN'S DIS START PCK PA; MO; QL (8 per 28 days) PA; MO; QL (8 per 28 days) PA; MO; QL (4 per 28 days) PA; MO; QL (4 per 28 days) PA; MO; QL (2 per 28 days) PA; MO; QL (3.2 per 28 days) PA; MO; QL (4.8 per 80 days) HUMIRA PEN PA; MO; QL (3.2 per 28 days) HUMIRA PSORIASIS STARTER PACK PA; MO; QL (3.2 per 80 days) leflunomide ; QL (30 ORENCIA PA; MO ORENCIA (WITH MALTOSE) PA; MO OTEZLA PA; MO OTEZLA STARTER PA; MO

53 Name RIDAURA OBSTETRICS / GYNECOLOGY ESTROGENS / PROGESTINS CAMILA DEPO-PROVERA INTRAMUSCULA R SOLUTION ERRIN ESTRACE VAGINAL estradiol oral estradiol transdermal estradiol valerate estradiolnorethindrone acet ; QL (4 per 28 days) estropipate JOLIVETTE LYZA medroxyprogesteron e intramuscular suspension medroxyprogesteron e oral MENEST MIMVEY MIMVEY LO NORA-BE norethindrone (contraceptive) norethindrone acetate progesterone micronized Name MISCELLANEOUS OB/GYN clindamycin phosphate vaginal metronidazole vaginal MICONAZOLE-3 VAGINAL SUPPOSITORY terconazole tranexamic acid oral VANDAZOLE XULANE ORAL CONTRACEPTIVES / RELATED AGENTS AMETHIA AMETHYST APRI ARANELLE (28) AVIANE BALZIVA (28) BRIELLYN CRYSELLE (28) CYCLAFEM /35 (28) CYCLAFEM 7/7/7 (28) drospirenone-ethinyl estradiol ELLA EMOQUETTE ENPRESSE GIANVI (28) GILDAGIA You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 52

54 Name INTROVALE JUNEL.5/30 (2) JUNEL /20 (2) JUNEL FE.5/30 (28) JUNEL FE /20 (28) KARIVA (28) KELNOR /35 (28) LARIN /20 (2) LARIN FE LEENA 28 LESSINA LEVONEST (28) levonorgestrelethinyl estrad oral tablets,dose pack,3 month LEVORA-28 LOMEDIA 24 FE LORYNA (28) LOW-OGESTREL (28) LUTERA (28) MARLISSA MICROGESTIN.5/30 (2) MICROGESTIN /20 (2) MICROGESTIN FE.5/30 (28) MICROGESTIN FE /20 (28) MONONESSA (28) NECON 0.5/35 (28) Name NECON /35 (28) NECON /50 (28) NECON 0/ (28) NECON 7/7/7 (28) NORTREL 0.5/35 (28) NORTREL /35 (2) NORTREL /35 (28) NORTREL 7/7/7 (28) OCELLA OGESTREL (28) ORSYTHIA PIMTREA (28) PIRMELLA ORAL TABLET -35 MG- MCG PORTIA PREVIFEM QUASENSE RECLIPSEN (28) SPRINTEC (28) SRONYX TRI-LEGEST FE TRI-PREVIFEM (28) TRI-SPRINTEC (28) TRINESSA (28) TRIVORA (28) You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 53

55 Name VELIVET TRIPHASIC REGIMEN (28) VESTURA (28) VYFEMLA (28) ZENCHENT (28) ZENCHENT FE ZOVIA /35E (28) ZOVIA /50E (28) OXYTOCICS methylergonovine oral OPHTHALMOLOGY ANTIBIOTICS bacitracin ophthalmic bacitracinpolymyxin b ophthalmic ciprofloxacin ophthalmic erythromycin ophthalmic gatifloxacin GENTAK OPHTHALMIC OINTMENT gentamicin ophthalmic drops gentamicin ophthalmic ointment levofloxacin ophthalmic NATACYN Name neomycinbacitracinpolymyxin neomycinpolymyxingramicidin ofloxacin ophthalmic polymyxin b sulftrimethoprim tobramycin ANTIVIRALS trifluridine ZIRGAN BETA-BLOCKERS betaxolol ophthalmic carteolol levobunolol ophthalmic drops 0.5 % metipranolol timolol maleate ophthalmic CHOLINESTERASE INHIBITOR MIOTICS PHOSPHOLINE IODIDE DIRECT ACTING MIOTICS pilocarpine hcl ophthalmic MISCELLANEOUS OPHTHALMOLOGICS azelastine ophthalmic cromolyn ophthalmic You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 54

56 Name CYSTARAN epinastine RESTASIS ; QL (60 NON-STEROIDAL ANTI- INFLAMMATORY AGENTS bromfenac diclofenac sodium ophthalmic flurbiprofen sodium ketorolac ophthalmic ORAL DRUGS FOR GLAUCOMA acetazolamide oral acetazolamide sodium methazolamide oral OTHER GLAUCOMA DRUGS dorzolamide dorzolamide-timolol latanoprost travoprost (benzalkonium) STEROID-ANTIBIOTIC COMBINATIONS neomycinbacitracin-poly-hc neomycinpolymyxin-dexameth neomycinpolymyxin-hc ophthalmic Name STEROIDS dexamethasone sodium phosphate ophthalmic FML S.O.P. PRED MILD prednisolone acetate prednisolone sodium phosphate ophthalmic STEROID-SULFONAMIDE COMBINATIONS BLEPHAMIDE BLEPHAMIDE S.O.P. tobramycindexamethasone sulfacetamideprednisolone SULFONAMIDES sulfacetamide sodium ophthalmic SYMPATHOMIMETICS ALPHAGAN P OPHTHALMIC DROPS 0. % apraclonidine brimonidine VASOCONSTRICTOR DECONGESTANTS naphazoline RESPIRATORY AND ALLERGY ANTIHISTAMINE / ANTIALLERGENIC AGENTS You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 55

57 Name ADRENALIN INJECTION SOLUTION MG/ML (:,000) (ML) cetirizine oral solution mg/ml desloratadine ; QL (30 diphenhydramine hcl injection solution diphenhydramine hcl oral elixir PA; MO EPIPEN QL (4 per 30 days) EPIPEN 2-PAK ; QL (4 per 30 days) EPIPEN JR QL (4 per 30 days) EPIPEN JR 2-PAK ; QL (4 per 30 days) hydroxyzine hcl oral tablet levocetirizine oral solution levocetirizine oral tablet promethazine injection solution PULMONARY AGENTS acetylcysteine solution PA; MO ; QL (30 B/D PA; MO ADEMPAS PA; MO; LA Name albuterol sulfate inhalation solution for nebulization 0.63 mg/3 ml,.25 mg/3 ml, 2.5 mg /3 ml (0.083 %), 5 mg/ml B/D PA; MO albuterol sulfate oral aminophylline intravenous solution 250 mg/0 ml ARCAPTA NEOHALER ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 0 MCG (30 DOSES), 220 MCG (30 DOSES) ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 220 MCG (20 DOSES) ASMANEX TWISTHALER INHALATION AEROSOL POWDR BREATH ACTIVATED 220 MCG (60 DOSES) ; QL (30 ; QL (30 ; QL (240 ; QL (60 ATROVENT HFA ; QL (25.8 budesonide inhalation B/D PA; MO budesonide nasal ; QL (7.2 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 56

58 Name CINRYZE PA; MO COMBIVENT RESPIMAT ; QL (8 per 30 days) cromolyn inhalation B/D PA; MO DALIRESP PA; MO DULERA PA; MO; QL (3 per 30 days) FIRAZYR PA; MO flunisolide ; QL (50 fluticasone nasal ; QL (6 ipratropium bromide inhalation ipratropiumalbuterol B/D PA; MO B/D PA; MO KALYDECO LETAIRIS PA; MO; LA levalbuterol hcl inhalation solution for nebulization 0.3 mg/3 ml, 0.63 mg/3 ml,.25 mg/0.5 ml B/D PA; MO metaproterenol montelukast OPSUMIT PA; MO; LA PERFOROMIST B/D PA; MO PROAIR HFA ; QL (7 PULMICORT INHALATION SUSPENSION FOR NEBULIZATION MG/2 ML B/D PA; MO PULMOZYME B/D PA; MO Name QVAR ; QL (7.4 REVATIO INTRAVENOUS SEREVENT DISKUS PA; MO ; QL (60 sildenafil PA; MO; QL (90 per 30 days) SPIRIVA WITH HANDIHALER SYMBICORT INHALATION HFA AEROSOL INHALER MCG/ACTUATION SYMBICORT INHALATION HFA AEROSOL INHALER MCG/ACTUATION ; QL (90 PA; MO; QL (0.2 per 30 days) PA; MO; QL (6.9 per 30 days) terbutaline oral terbutaline subcutaneous theophylline oral solution theophylline oral tablet extended release theophylline oral tablet extended release 2 hr TRACLEER PA; MO; LA triamcinolone acetonide nasal ; QL (6.5 TYVASO B/D PA; MO You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 57

59 Name XOLAIR PA; MO; LA; QL (6 per 28 days) zafirlukast UROLOGICALS ANTICHOLINERGICS / ANTISPASMODICS flavoxate oxybutynin chloride oral tolterodine trospium BENIGN PROSTATIC HYPERPLASIA(BPH) THERAPY alfuzosin finasteride oral tablet 5 mg tamsulosin CHOLINERGIC STIMULANTS bethanechol chloride MISCELLANEOUS UROLOGICALS ammonium chloride CYSTAGON ; LA ELMIRON potassium citrate oral tablet extended release 0 meq, 5 meq VITAMINS, HEMATINICS / ELECTROLYTES ELECTROLYTES calcium acetate oral capsule ELIPHOS You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 58 Name KLOR-CON 0 KLOR-CON 8 KLOR-CON M5 KLOR-CON M20 lactated ringers intravenous magnesium sulfate injection syringe NORMOSOL-R IN 5 % DEXTROSE potassium chloridd5-0.45%nacl intravenous parenteral solution 0 meq/l, 30 meq/l, 40 meq/l potassium chloridd5-0.45%nacl intravenous parenteral solution 20 meq/l potassium chloride intravenous parenteral solution potassium chloride intravenous piggyback 0 meq/00 ml, 20 meq/00 ml, 40 meq/00 ml potassium chloride oral capsule, extended release potassium chloride oral tablet,er particles/crystals potassium chloride in 0.9%nacl

60 Name potassium chloride in 5 % dex intravenous parenteral solution 20 meq/l, 40 meq/l potassium chloride in lr-d5 intravenous parenteral solution 20 meq/l potassium chloride % nacl potassium chlorided5-0.2%nacl intravenous parenteral solution 20 meq/l potassium chlorided5-0.3%nacl potassium chlorided5-0.9%nacl ringers intravenous sodium chloride intravenous parenteral solution 2.5 meq/ml sodium chloride 0.45 % intravenous parenteral solution sodium chloride 3 % sodium chloride 5 % sodium lactate intravenous MISCELLANEOUS NUTRITION PRODUCTS AMINOSYN 8.5 %- ELECTROLYTES AMINOSYN II 0 % B/D PA B/D PA Name AMINOSYN II 5 % B/D PA AMINOSYN II 7 % B/D PA AMINOSYN II 8.5 % AMINOSYN II 8.5 %- ELECTROLYTES AMINOSYN M 3.5 % AMINOSYN-PF 0 % AMINOSYN-PF 7 % (SULFITE- FREE) CLINIMIX 5%/D5W SULFITE FREE CLINIMIX 5%/D25W SULFITE-FREE CLINIMIX 2.75%/D5W SULFIT FREE CLINIMIX 4.25%- D20W SULF-FREE CLINIMIX 4.25%- D25W SULF-FREE CLINIMIX 4.25%/D0W SULF FREE CLINIMIX 5%- D20W(SULFITE- FREE) CLINIMIX E 4.25%/D25W SUL FREE B/D PA B/D PA B/D PA B/D PA B/D PA B/D PA B/D PA B/D PA B/D PA B/D PA B/D PA B/D PA You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 59

61 Name CLINIMIX E 4.25%/D5W SULF FREE CLINIMIX E 5%/D5W SULFIT FREE CLINIMIX E 5%/D20W SULFIT FREE CLINIMIX E 5%/D25W SULFIT FREE HEPATAMINE 8% B/D PA HEPATASOL 8 % B/D PA INTRALIPID INTRAVENOUS EMULSION 20 % IONOSOL-B IN D5W IONOSOL-MB IN D5W ISOLYTE-P IN 5 % DEXTROSE ISOLYTE-S LIPOSYN III INTRAVENOUS EMULSION 0 %, 20 % NEPHRAMINE 5.4 % NORMOSOL-M IN 5 % DEXTROSE NORMOSOL-R PH 7.4 PLASMA-LYTE 48 PLASMA-LYTE A B/D PA; MO B/D PA B/D PA Name PLASMA-LYTE-56 IN 5 % DEXTROSE PREMASOL 0 % B/D PA PREMASOL 6 % B/D PA PROCALAMINE 3% B/D PA TRAVASOL 0 % B/D PA TROPHAMINE 0 % B/D PA TROPHAMINE 6% B/D PA VITAMINS / HEMATINICS PRENATAL VITAMIN sodium fluoride oral tablet You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 60

62 Index 8 8-MOP...37 A abacavir...8 abacavir-lamivudinezidovudine...8 ABELCET...8 ABILIFY...26 ABILIFY DISCMELT...26 ABILIFY MAINTENA...26 ABRAXANE...5 acamprosate...39 acarbose...42 acebutolol...33 acetaminophen-codeine...22 ACETASOL HC...4 acetazolamide...55 acetazolamide sodium...55 acetic acid...4 acetylcysteine...56 acitretin...37 ACTEMRA...5 ACTHIB (PF)...49 ACTIMMUNE...48 acyclovir...8, 38 acyclovir sodium...8 ADACEL(TDAP ADOLESN/ADULT)(PF) 49 ADAGEN...39 adapalene...37 adefovir...8 ADEMPAS...56 ADRENALIN...56 ADVICOR...36 AFEDITAB CR...33 AFINITOR...5 AFINITOR DISPERZ...5 AGGRENOX...35 A-HYDROCORT...4 ALA-CORT...38 ALBENZA... albuterol sulfate...56 alclometasone...38 ALCOHOL PADS...42 ALDURAZYME...44 alendronate...40, 5 alfuzosin...58 ALIMTA...5 ALINIA... allopurinol...5 ALOPRIM...5 ALOXI...46 ALPHAGAN P...55 alprazolam...26 amantadine hcl...8 AMBISOME...8 amcinonide...38 AMETHIA...52 AMETHYST...52 amifostine crystalline...4 amikacin... amiloride...33 amiloride-hydrochlorothiazide...33 aminophylline...56 AMINOSYN 8.5 %- ELECTROLYTES...59 AMINOSYN II 0 %...59 AMINOSYN II 5 %...59 AMINOSYN II 7 %...59 AMINOSYN II 8.5 %...59 AMINOSYN II 8.5 %- ELECTROLYTES...59 AMINOSYN M 3.5 %...59 AMINOSYN-PF 0 %...59 AMINOSYN-PF 7 % (SULFITE-FREE)...59 amiodarone...32 AMITIZA...46 amitriptyline...26 amlodipine...33 amlodipine-atorvastatin...36 amlodipine-benazepril...33 ammonium chloride...58 ammonium lactate...37 AMNESTEEM...37 amoxapine...26 amoxicil-clarithromy-lansopraz...47 amoxicillin...3 amoxicillin-pot clavulanate..3 AMPHETAMINE SALT COMBO...26 amphotericin b...8 ampicillin...3 ampicillin sodium...3 ampicillin-sulbactam...3 AMPYRA...2 ANADROL anagrelide...40 anastrozole...5 ANDROGEL...44 ANDROXY...44 APEXICON E...38 APOKYN...2 apraclonidine...55 APRI...52 APTIOM...20 APTIVUS...8 ARALAST NP...40 ARANELLE (28)...52 ARCALYST...48 ARCAPTA NEOHALER...56 ARRANON...5 ARZERRA...5 ASMANEX TWISTHALER56 atenolol...33 atenolol-chlorthalidone...33 ATGAM...49 atorvastatin...36 atovaquone... atovaquone-proguanil... ATRIPLA...8 atropine...46 ATROVENT HFA...56 AUGMENTIN...3 AVASTIN...5 AVELOX IN NACL (ISO- OSMOTIC)...3 AVIANE...52 AVITA...37 AVONEX...48 AVONEX ADMINISTRATION PACK...48 azacitidine...5 AZASAN...5 You can find information on what the symbols and abbreviations on this table mean by going to the beginning of this table. 6

63 azathioprine...5 azelastine...4, 54 AZILECT...2 azithromycin... aztreonam... B BACIIM... bacitracin..., 54 bacitracin-polymyxin b...54 baclofen...22 balsalazide...46 BALZIVA (28)...52 BANZEL...20 BARACLUDE...8 bcg vaccine, live (pf)...49 benazepril...33 benazepril-hydrochlorothiazide...33 BENLYSTA...5 benztropine...2 betamethasone dipropionate.38 betamethasone valerate...38 betamethasone, augmented...38 BETASERON...48 betaxolol...33, 54 bethanechol chloride...58 BETHKIS... bicalutamide...5 BICILLIN C-R...3 BICILLIN L-A...3 BICNU...5 bisoprolol fumarate...33 bisoprolol-hydrochlorothiazide...33 bleomycin...5 BLEPHAMIDE...55 BLEPHAMIDE S.O.P...55 BOOSTRIX TDAP...49 BOSULIF...5 BOTOX...49 BRIELLYN...52 BRILINTA...35 brimonidine...55 BRINTELLIX...26 bromfenac...55 bromocriptine...2 budesonide...46, 56 bumetanide...33 buprenorphine...22 buprenorphine-naloxone...25 BUPROBAN...4 bupropion hcl...26 buspirone...27 BUSULFEX...5 butorphanol tartrate...25 BYDUREON...42 BYETTA...42 C cabergoline...44 calcipotriene...37 calcipotriene-betamethasone 37 calcitonin (salmon)...45 calcitriol...37, 45 calcium acetate...58 CAMILA...52 CANASA...46 CANCIDAS...8 candesartan...33 candesartan-hydrochlorothiazid...33 CAPASTAT... CAPRELSA...5 captopril...33 captopril-hydrochlorothiazide...33 CARAC...37 CARAFATE...47 CARBAGLU...40 carbamazepine...20 carbidopa...2 carbidopa-levodopa...2 carbidopa-levodopaentacapone...2 carboplatin...5 CARIMUNE NF NANOFILTERED...49 carteolol...54 CARTIA XT...33 carvedilol...33 CAYSTON... cefaclor...0 cefadroxil...0 cefazolin...0 cefazolin in dextrose (iso-os)0 cefdinir...0 cefditoren pivoxil...0 cefepime...0 cefotaxime...0 cefotetan...0 cefoxitin cefoxitin in dextrose, iso-osm...0 cefpodoxime...0 cefprozil...0 ceftazidime...0 ceftriaxone...0 cefuroxime axetil...0 cefuroxime sodium...0 CELEBREX...25 CELLCEPT...5 CELLCEPT INTRAVENOUS...5 CELONTIN...20 cephalexin...0 CEREZYME...45 CERVARIX VACCINE (PF)...49 CESAMET...46 cetirizine...56 cevimeline...40 CHANTIX...4 CHANTIX CONTINUING MONTH BOX...4 CHANTIX CONTINUING MONTH PAK...4 CHANTIX STARTING MONTH BOX...4 CHANTIX STARTING MONTH PAK...4 CHEMET...40 CHENODAL...46 chloramphenicol sod succinate... chlorhexidine gluconate...4 chloroquine phosphate... chlorothiazide...33 chlorothiazide sodium...33 chlorpromazine...27 chlorthalidone...33 CHOLESTYRAMINE LIGHT...36 chorionic gonadotropin, human...45 ciclopirox...38 cidofovir...8 cilostazol...35 cimetidine...47 CINRYZE...57 CIPRODEX...4 ciprofloxacin...3, 54 ciprofloxacin (mixture)...3

64 ciprofloxacin in 5 % dextrose..4 cisplatin...5 citalopram...27 cladribine...5 CLARAVIS...37 clarithromycin... clindamycin hcl... clindamycin in dextrose 5 % CLINDAMYCIN PEDIATRIC... clindamycin phosphate.., 37, 52 clindamycin-benzoyl peroxide...37 CLINIMIX 5%/D5W SULFITE FREE...59 CLINIMIX 5%/D25W SULFITE-FREE...59 CLINIMIX 2.75%/D5W SULFIT FREE...59 CLINIMIX 4.25%/D0W SULF FREE...59 CLINIMIX 4.25%/D5W SULFIT FREE...40 CLINIMIX 4.25%-D20W SULF-FREE...59 CLINIMIX 4.25%-D25W SULF-FREE...59 CLINIMIX 5%- D20W(SULFITE-FREE).59 CLINIMIX E 2.75%/D0W SUL FREE...40 CLINIMIX E 2.75%/D5W SULF FREE...40 CLINIMIX E 4.25%/D25W SUL FREE...59 CLINIMIX E 4.25%/D5W SULF FREE...60 CLINIMIX E 5%/D5W SULFIT FREE...60 CLINIMIX E 5%/D20W SULFIT FREE...60 CLINIMIX E 5%/D25W SULFIT FREE...60 clobetasol...38, 39 clobetasol-emollient...39 CLOLAR...5 clomipramine...27 clonazepam...20 clonidine...33 clonidine hcl...27, 33 clopidogrel...35 clorazepate dipotassium...27 CLORPRES...33 clotrimazole...8, 38 clotrimazole-betamethasone.38 clozapine...27 COARTEM... codeine sulfate...22 colchicine-probenecid...5 COLCRYS...5 colestipol...36 colistin (colistimethate na)... COLOCORT...46 COMBIVENT RESPIMAT.57 COMETRIQ...5 COMPLERA...8 COMPRO...46 COMVAX (PF)...49 CONSTULOSE...46 COPAXONE...2 CORTIFOAM...46 cortisone...4 CREON...46 CRIXIVAN...8 cromolyn...46, 54, 57 CRYSELLE (28)...52 CUBICIN... CUPRIMINE...5 CYCLAFEM /35 (28)...52 CYCLAFEM 7/7/7 (28)...52 cyclobenzaprine...22 cyclophosphamide...5 CYCLOSET...42 cyclosporine...5 cyclosporine modified...5 CYSTADANE...46 CYSTAGON...58 CYSTARAN...55 cytarabine...5 cytarabine (pf)...6 D d0 % & 0.45 % sodium chloride...40 d2.5 %-0.45 % sodium chloride...40 d5 % and 0.9 % sodium chloride...40 d5 %-0.45 % sodium chloride...40 dacarbazine...6 DALIRESP...57 danazol...45 dantrolene...22 dapsone...2 DAPTACEL (DTAP PEDIATRIC) (PF)...49 DARAPRIM...2 daunorubicin...6 decitabine...6 demeclocycline...4 DEMSER...33 DENAVIR...38 DEPEN TITRATABS...5 DEPO-PROVERA...52 desipramine...27 desloratadine...56 desmopressin...45 desonide...39 desoximetasone...39 dexamethasone...4 DEXAMETHASONE INTENSOL...4 dexamethasone sodium phosphate...4, 55 dexmethylphenidate...27 dexrazoxane...4 dextroamphetamine...27 dextroamphetamineamphetamine...27 dextrose 0 % & 0.2 % nacl.40 dextrose 0 % in water (d0w)...40 dextrose 5 % in water (d5w).40 dextrose 5 %-lactated ringers40 dextrose 5%-0.2 % sod chloride...40 dextrose 5%-0.3 % sod.chloride...40 diazepam...20, 27 DIAZEPAM INTENSOL...27 DIBENZYLINE...33 diclofenac potassium...25 diclofenac sodium...25, 37, 55 diclofenac-misoprostol...25 dicloxacillin...3 dicyclomine...46 didanosine...8 diflorasone...39 diflunisal

65 digoxin...35 dihydroergotamine...2 DILANTIN...20 diltiazem hcl...33, 34 DILT-XR...33 DIPENTUM...46 diphenhydramine hcl...56 diphenoxylate-atropine...46 dipyridamole...35 disulfiram...40 divalproex...20 DOCEFREZ...6 docetaxel...6 donepezil...2 DORIBAX...2 dorzolamide...55 dorzolamide-timolol...55 doxazosin...34 doxepin...27 doxercalciferol...45 DOXIL...6 doxorubicin...6 doxycycline hyclate...4 doxycycline monohydrate...4 dronabinol...46 drospirenone-ethinyl estradiol...52 DROXIA...6 DULERA...57 duloxetine...27 DURAMORPH (PF)...22 DUTOPROL...34 E E.E.S E.E.S. GRANULES... econazole...38 EDURANT...8 EFFIENT...35 EGRIFTA...48 ELAPRASE...45 ELELYSO...45 ELIGARD...6 ELIPHOS...58 ELIQUIS...35 ELITEK...4 ELLA...52 ELMIRON...58 EMCYT...6 EMEND...46 EMOQUETTE...52 EMSAM...27 EMTRIVA...8 enalapril maleate...34 enalapril-hydrochlorothiazide...34 ENBREL...5 ENBREL SURECLICK...5 ENDOCET...22 ENDODAN...23 ENGERIX-B (PF)...49 ENGERIX-B PEDIATRIC (PF)...50 enoxaparin...35 ENPRESSE...52 entacapone...2 ENULOSE...46 epinastine...55 EPIPEN...56 EPIPEN 2-PAK...56 EPIPEN JR...56 EPIPEN JR 2-PAK...56 epirubicin...6 EPITOL...20 EPIVIR...8 EPIVIR HBV...8 eplerenone...34 eprosartan...34 EPZICOM...8 ERBITUX...6 ergoloid...27 ERGOMAR...2 ERIVEDGE...6 ERRIN...52 ERWINAZE...6 ERY PADS...37 ERYPED ERYPED ERY-TAB... ERYTHROCIN... ERYTHROCIN (AS STEARATE)... erythromycin..., 54 erythromycin ethylsuccinate. erythromycin with ethanol...37 erythromycin-benzoyl peroxide...37 erythromycin-sulfisoxazole.. escitalopram oxalate...27 esomeprazole sodium...47 ESTRACE...52 estradiol...52 estradiol valerate...52 estradiol-norethindrone acet.52 estropipate...52 eszopiclone...27 ethambutol...2 ethosuximide...20 etidronate disodium...40 etodolac...25 ETOPOPHOS...6 etoposide...6 EXELON...2 exemestane...6 EXJADE...40 F FABRAZYME...45 famciclovir...8 famotidine...47 famotidine (pf)...47 famotidine (pf)-nacl (iso-os)47 FANAPT...27 FARESTON...6 FASLODEX...6 FAZACLO...28 felbamate...20 felodipine...34 fenofibrate...36 fenofibrate micronized...36 fenofibrate nanocrystallized.36 fenofibric acid (choline)...36 fenoprofen...25 fentanyl citrate...23 fentanyl patches...23 FERRIPROX...40 FETZIMA...28 finasteride...58 FIRAZYR...57 FIRMAGON KIT W DILUENT SYRINGE...6 flavoxate...58 flecainide...32 fluconazole...8 fluconazole in dextrose(iso-o) 8 flucytosine...8 fludarabine...6 fludrocortisone...4 flunisolide...57 fluocinolone...39 fluocinolone acetonide oil...4 fluocinonide

66 FLUOCINONIDE-E...39 fluorouracil...6, 37 fluoxetine...28 fluphenazine decanoate...28 fluphenazine hcl...28 flurbiprofen...25 flurbiprofen sodium...55 flutamide...6 fluticasone...39, 57 fluvastatin...36 fluvoxamine...28 FML S.O.P FOLOTYN...6 fomepizole...50 fondaparinux...35 FORTEO...5 FORTICAL...45 foscarnet...8 fosinopril...34 fosinopril-hydrochlorothiazide...34 fosphenytoin...20 furosemide...34 FUSILEV...4 FUZEON...8 FYCOMPA...20 G gabapentin...20 GABITRIL...20 GABLOFEN...22 galantamine...22 GAMASTAN S/D...50 GAMUNEX-C...50 ganciclovir sodium...8 GARDASIL (PF)...50 gatifloxacin...54 gauze pads 2 x GAVILYTE-C...46 GAVILYTE-G...46 GAVILYTE-N...46 gemcitabine...6 gemfibrozil...36 GENERLAC...46 GENGRAF...6 GENTAK...54 gentamicin...2, 38, 54 gentamicin in nacl (iso-osm) 2 gentamicin sulfate (pf)...2 GEODON...28 GIANVI (28)...52 GILDAGIA...52 GILENYA...22 GILOTRIF...6 GLEEVEC...6 glimepiride...42 glipizide...42, 43 glipizide-metformin...43 GLUCAGEN...43 GLUCAGEN HYPOKIT...43 GLUCAGON EMERGENCY...43 glycopyrrolate...46 granisetron...46 granisetron (pf)...46 GRANISOL...46 griseofulvin microsize...8 griseofulvin ultramicrosize...8 guanidine...28 H HALAVEN...7 halobetasol propionate...39 haloperidol...28 haloperidol decanoate...28 haloperidol lactate...28 HAVRIX (PF)...50 heparin (porcine)...35 heparin (porcine) in 5 % dex 35 heparin (porcine) in nacl (pf)35 HEPATAMINE 8%...60 HEPATASOL 8 %...60 HERCEPTIN...7 HEXALEN...7 HUMALOG...43 HUMALOG KWIKPEN...43 HUMALOG MIX HUMALOG MIX KWIKPEN...43 HUMALOG MIX HUMALOG MIX KWIKPEN...43 HUMIRA...5 HUMIRA CROHN'S DIS START PCK...5 HUMIRA PEN...5 HUMIRA PSORIASIS STARTER PACK...5 HUMULIN 70/ HUMULIN 70/30 KWIKPEN...43 HUMULIN 70/30 PEN...43 HUMULIN N...43 HUMULIN N KWIKPEN...43 HUMULIN N PEN...43 HUMULIN R...43 HUMULIN R U hydralazine...34 hydrochlorothiazide...34 hydrocodone-acetaminophen23 hydrocodone-ibuprofen...23 hydrocortisone...39, 4, 46 hydrocortisone butyrate...39 hydrocortisone butyr-emollient...39 hydrocortisone valerate...39 hydrocortisone-acetic acid...4 hydromorphone...23 hydromorphone (pf)...23 hydroxychloroquine...2 hydroxyurea...7 hydroxyzine hcl...56 I ibandronate...5 ibuprofen...25 ibuprofen-oxycodone...23 idarubicin...7 ifosfamide...7 ILARIS (PF)...48 IMBRUVICA...7 imipenem-cilastatin...2 imipramine hcl...28 imipramine pamoate...28 imiquimod...37 IMOVAX RABIES VACCINE (PF)...50 INCRELEX...40 indapamide...34 INFANRIX (DTAP) (PF)...50 INLYTA...7 insulin pen needle...43 insulin syringe (disp) u ml...43 insulin syringe (disp) u-00 ml...43 insulin syringe (disp) u-00 /2 ml...43 INTELENCE...8, 9 INTRALIPID...60 INTRON A...48 INTROVALE...53 INVANZ

67 INVEGA...28, 29 INVEGA SUSTENNA...29 INVIRASE...9 INVOKANA...43 IONOSOL-B IN D5W...60 IONOSOL-MB IN D5W...60 IPOL...50 ipratropium bromide...4, 57 ipratropium-albuterol...57 irbesartan...34 irbesartan-hydrochlorothiazide...34 irinotecan...7 ISENTRESS...9 ISOLYTE-P IN 5 % DEXTROSE...60 ISOLYTE-S...60 isoniazid...2 isosorbide dinitrate...36 isosorbide mononitrate...36 isradipine...34 ISTODAX...7 itraconazole...8 IXEMPRA...7 IXIARO (PF)...50 J JAKAFI...7 JANTOVEN...35 JANUMET...43 JANUMET XR...43 JANUVIA...43 JENTADUETO...43 JEVTANA...7 JOLIVETTE...52 JUNEL.5/30 (2)...53 JUNEL /20 (2)...53 JUNEL FE.5/30 (28)...53 JUNEL FE /20 (28)...53 JUXTAPID...36 K KADCYLA...7 KALETRA...9 KALYDECO...57 KARIVA (28)...53 KELNOR /35 (28)...53 KEPIVANCE...4 ketoconazole...8, 38 KETODAN KIT...38 ketoprofen...25 ketorolac...55 KIONEX...40 KLOR-CON KLOR-CON KLOR-CON M KLOR-CON M KUVAN...45 KYNAMRO...36 L labetalol...34 lactated ringers...39, 58 lactulose...46 LAMISIL...8 lamivudine...9 lamivudine-zidovudine...9 lamotrigine...20 LANOXIN...35 lansoprazole...47, 48 LANTUS...43 LANTUS SOLOSTAR...43 LARIN /20 (2)...53 LARIN FE...53 latanoprost...55 LATUDA...29 LEENA leflunomide...5 LESSINA...53 LETAIRIS...57 letrozole...7 leucovorin calcium...5 LEUKERAN...7 LEUKINE...48 leuprolide...7 levalbuterol hcl...57 LEVEMIR...43 LEVEMIR FLEXPEN...43 LEVEMIR FLEXTOUCH...44 levetiracetam...20 levobunolol...54 levocarnitine...40 levocarnitine (with sugar)...40 levocetirizine...56 levofloxacin...4, 54 levofloxacin in d5w...4 LEVONEST (28)...53 levonorgestrel-ethinyl estrad 53 LEVORA levorphanol tartrate...23 levothyroxine...45 LEVOXYL...45 LEXIVA...9 LIALDA...46 lidocaine...38 lidocaine (pf)...38 lidocaine hcl...38 lidocaine-prilocaine...38 lindane...39 LINZESS...46 LIORESAL...22 liothyronine...45 LIPOSYN III...60 lisinopril...34 lisinopril-hydrochlorothiazide...34 lithium carbonate...29 lithium citrate...29 LOMEDIA 24 FE...53 lomustine...7 loperamide...46 lorazepam...29 LORAZEPAM INTENSOL.29 LORCET (HYDROCODONE)...23 LORCET HD...23 LORCET PLUS...23 LORTAB LORTAB LORTAB LORYNA (28)...53 losartan...34 losartan-hydrochlorothiazide 34 LOTRONEX...46 lovastatin...36 LOW-OGESTREL (28)...53 loxapine succinate...29 LUMIZYME...45 LUPRON DEPOT...7 LUPRON DEPOT (3 MONTH)...7 LUPRON DEPOT (4 MONTH)...7 LUPRON DEPOT (6 MONTH)...7 LUPRON DEPOT-PED...7 LUTERA (28)...53 LYRICA...20 LYSODREN...7 LYZA...52 M MACRODANTIN...4 mafenide acetate

68 magnesium sulfate...58 malathion...39 maprotiline...29 MARLISSA...53 MARPLAN...29 MATULANE...7 MATZIM LA...34 meclizine...46 meclofenamate...25 medroxyprogesterone...52 mefenamic acid...25 mefloquine...2 megestrol...7 MEKINIST...7 meloxicam...25 melphalan...7 MENACTRA (PF)...50 MENEST...52 MENOMUNE - A/C/Y/W-35 (PF)...50 MENVEO A-C-Y-W-35-DIP (PF)...50 mercaptopurine...7 meropenem...2 mesalamine with cleansing wipe...46 mesna...5 MESNEX...5 MESTINON...22 MESTINON TIMESPAN...22 METADATE ER...29 metaproterenol...57 metformin...44 methadone...23, 24 methamphetamine...29 methazolamide...55 methenamine hippurate...4 methimazole...42 METHITEST...45 methotrexate sodium...7 methotrexate sodium (pf)...7 methoxsalen rapid...37 methyclothiazide...34 methyldopa...34 methylergonovine...54 methylphenidate...29 methylprednisolone...4, 42 methylprednisolone acetate..42 methylprednisolone sodium succ...42 metipranolol...54 metoclopramide hcl...46, 47 metolazone...34 metoprolol succinate...34 metoprolol ta-hydrochlorothiaz...34 metoprolol tartrate...34 metronidazole...2, 37, 52 metronidazole in nacl (iso-os)...2 mexiletine...32 MIACALCIN...45 MICONAZOLE MICROGESTIN.5/30 (2) 53 MICROGESTIN /20 (2)...53 MICROGESTIN FE.5/30 (28)...53 MICROGESTIN FE /20 (28)...53 midodrine...40 MIGERGOT...2 MILLIPRED...42 MIMVEY...52 MIMVEY LO...52 minocycline...4 minoxidil...34 mirtazapine...29 misoprostol...48 mitomycin...8 mitoxantrone...8 M-M-R II (PF)...50 modafinil...29 MODERIBA...9 MODERIBA DOSE PACK...9 moexipril...34 moexipril-hydrochlorothiazide...34 mometasone...39 MONONESSA (28)...53 montelukast...57 morphine...24 morphine concentrate...24 moxifloxacin...4 MOZOBIL...49 mupirocin...38 mupirocin calcium...38 MUSTARGEN...8 MYALEPT...45 MYCAMINE...8 mycophenolate mofetil...8 mycophenolate sodium...8 MYORISAN...37 MYOZYME...45 N nabumetone...25 nadolol...34 nadolol-bendroflumethiazide34 nafcillin...3 nafcillin in dextrose iso-osm 3 NAGLAZYME...45 nalbuphine...25 naloxone...25 naltrexone...25 NAMENDA...22 NAMENDA TITRATION PAK...22 naphazoline...55 naproxen...25 naproxen sodium...25 naratriptan...2 NATACYN...54 nateglinide...44 NEBUPENT...2 NECON 0.5/35 (28)...53 NECON /35 (28)...53 NECON /50 (28)...53 NECON 0/ (28)...53 NECON 7/7/7 (28)...53 needles, insulin disp.,safety..44 nefazodone...29 neomycin...2 neomycin-bacitracin-poly-hc55 neomycin-bacitracinpolymyxin...54 neomycin-polymyxin b gu...39 neomycin-polymyxindexameth...55 neomycin-polymyxingramicidin...54 neomycin-polymyxin-hc.4, 55 NEPHRAMINE 5.4 %...60 NEULASTA...49 NEUMEGA...49 NEUPOGEN...49 NEUPRO...2 nevirapine...9 NEXAVAR...8 niacin...36 nicardipine...34 NICOTROL

69 NICOTROL NS...4 NIFEDICAL XL...34 nifedipine...34 NILANDRON...8 nimodipine...34 nisoldipine...34 NITRO-BID...36 nitrofurantoin...4 nitrofurantoin macrocrystal..4 nitrofurantoin monohyd/mcryst...4 nitroglycerin...36, 37 NITROSTAT...37 nizatidine...48 NORA-BE...52 norethindrone (contraceptive)...52 norethindrone acetate...52 NORMOSOL-M IN 5 % DEXTROSE...60 NORMOSOL-R IN 5 % DEXTROSE...58 NORMOSOL-R PH NORTREL 0.5/35 (28)...53 NORTREL /35 (2)...53 NORTREL /35 (28)...53 NORTREL 7/7/7 (28)...53 nortriptyline...29 NORVIR...9 NOVAREL...45 NOVOLOG...44 NOVOLOG FLEXPEN...44 NOVOLOG MIX NOVOLOG MIX FLEXPEN...44 NOVOLOG PENFILL...44 NOXAFIL...8 NUEDEXTA...22 NULOJIX...8 NYAMYC...38 nystatin...8, 38 nystatin-triamcinolone...38 NYSTOP...38 O OCELLA...53 octreotide acetate...8 ofloxacin...4, 4, 54 OGESTREL (28)...53 olanzapine...29, 30 olanzapine-fluoxetine...30 OLYSIO...9 omega-3 acid ethyl esters...36 omeprazole...48 omeprazole-sodium bicarbonate...48 OMNITROPE...49 ONCASPAR...8 ondansetron...47 ondansetron hcl...47 ondansetron hcl (pf)...47 ONFI...20 OPSUMIT...57 ORAP...30 ORENCIA...5 ORENCIA (WITH MALTOSE)...5 ORFADIN...40 ORSYTHIA...53 OTEZLA...5 OTEZLA STARTER...5 oxacillin...3 oxacillin in dextrose(iso-osm)...3 oxaliplatin...8 oxandrolone...45 oxaprozin...25 oxazepam...30 oxcarbazepine...20 OXSORALEN...37 oxybutynin chloride...58 oxycodone...24 oxycodone-acetaminophen...24 oxycodone-aspirin...24 oxymorphone...24, 25 P PACERONE...32 paclitaxel...8 pamidronate...45 PANRETIN...37 pantoprazole...48 paricalcitol...45 paromomycin...2 paroxetine hcl...30 PASER...2 PAXIL...30 PEDI-DRI...38 PEDVAX HIB (PF)...50 peg 3350-electrolytes...47 PEGANONE...20 PEGASYS...49 PEGASYS CONVENIENCE PACK...49 PEGASYS PROCLICK...49 PEGINTRON...49 PEGINTRON REDIPEN...49 penicillin g potassium...3 penicillin g procaine...3 penicillin g sodium...3 penicillin v potassium...3 PENTAM...2 PENTASA...47 pentoxifylline...36 PERFOROMIST...57 perindopril erbumine...34 PERIOGARD...4 PERJETA...8 permethrin...39 perphenazine...30 perphenazine-amitriptyline...30 PFIZERPEN-G...3 phenelzine...30 phenobarbital...20 phenytoin...20 phenytoin sodium...20 phenytoin sodium extended..20 PHOSPHOLINE IODIDE...54 pilocarpine hcl...40, 54 PIMTREA (28)...53 pindolol...34 pioglitazone...44 pioglitazone-glimepiride...44 pioglitazone-metformin...44 piperacillin-tazobactam...3 PIRMELLA...53 piroxicam...25 PLASMA-LYTE PLASMA-LYTE A...60 PLASMA-LYTE-56 IN 5 % DEXTROSE...60 podofilox...37 polyethylene glycol polymyxin b sulfate...2 polymyxin b sulf-trimethoprim...54 POMALYST...8 PORTIA...53 potassium chlorid-d5-0.45%nacl...58 potassium chloride

70 potassium chloride in 0.9%nacl...58 potassium chloride in 5 % dex...59 potassium chloride in lr-d potassium chloride-0.45 % nacl...59 potassium chloride-d5-0.2%nacl...59 potassium chloride-d5-0.3%nacl...59 potassium chloride-d5-0.9%nacl...59 potassium citrate...58 POTIGA...20 pramipexole...2 pravastatin...36 prazosin...34 PRED MILD...55 prednicarbate...39 prednisolone acetate...55 prednisolone sodium phosphate...42, 55 prednisone...42 PREDNISONE INTENSOL 42 PREMASOL 0 %...60 PREMASOL 6 %...60 PRENATAL VITAMIN...60 PREVALITE...36 PREVIFEM...53 PREZISTA...9 PRIFTIN...2 primaquine...2 primidone...20 PRIMSOL...4 PRISTIQ...30 PRIVIGEN...50 PROAIR HFA...57 probenecid...5 procainamide...32 PROCALAMINE 3%...60 PROCENTRA...30 prochlorperazine...47 prochlorperazine edisylate...47 prochlorperazine maleate...47 PROCRIT...49 PROCTO-PAK...47 PROCTOZONE-HC...47 progesterone micronized...52 PROGLYCEM...44 PROGRAF...8 PROLASTIN-C...40 PROLEUKIN...49 PROLIA...5 PROMACTA...36 promethazine...56 propafenone...33 propranolol...34 propranolol-hydrochlorothiazid...35 propylthiouracil...42 PROQUAD (PF)...50 PROTOPIC...37 protriptyline...30 PRUDOXIN...37 PULMICORT...57 PULMOZYME...57 pyrazinamide...2 pyridostigmine bromide...22 Q QUASENSE...53 quetiapine...30 quinapril...35 quinapril-hydrochlorothiazide...35 quinidine gluconate...33 quinidine sulfate...33 quinine sulfate...2 QVAR...57 R RABAVERT (PF)...50 rabeprazole...48 RAGWITEK...50 raloxifene...5 ramipril...35 RANEXA...36 ranitidine hcl...48 RAPAMUNE...8 RAVICTI...40 REBIF (WITH ALBUMIN).49 REBIF REBIDOSE...49 REBIF TITRATION PACK.49 RECLIPSEN (28)...53 RECOMBIVAX HB (PF)...50 RECTIV...47 REGRANEX...37 RELENZA DISKHALER...9 RELISTOR...47 REMICADE...47 REMODULIN...35 RENVELA...40 repaglinide...44 REPREXAIN...25 RESCRIPTOR...9 RESTASIS...55 RETROVIR...9 REVATIO...57 REVLIMID...8 REYATAZ...9 RIBAPAK DOSE PACK...9 RIBASPHERE...9 ribavirin...9 RIDAURA...52 rifabutin...2 rifampin...2 riluzole...40 rimantadine...9 ringers...39, 59 RIOMET...44 risedronate...5 RISPERDAL CONSTA...30 risperidone...30, 3 RITUXAN...8 rivastigmine tartrate...22 rizatriptan...2 ropinirole...2 ROTARIX...50 ROTATEQ VACCINE...50 ROZEREM...3 S SABRIL...2 SAIZEN...49 SAIZEN CLICK.EASY...49 SAMSCA...45 SANDOSTATIN LAR DEPOT...8 SANTYL...39 SAPHRIS...3 SAPHRIS (BLACK CHERRY)...3 selegiline hcl...2 selenium sulfide...37 SELZENTRY...9 SENSIPAR...45 SEREVENT DISKUS...57 SEROQUEL XR...3 sertraline...3 SIGNIFOR...8 sildenafil...57 silver sulfadiazine

71 SIMULECT...8 simvastatin...36 sirolimus...8 SIRTURO...2 sodium chloride...40, 59 sodium chloride 0.45 %...59 sodium chloride 0.9 %...40 sodium chloride 3 %...59 sodium chloride 5 %...59 sodium fluoride...60 sodium lactate...59 sodium phenylbutyrate...40 SODIUM POLYSTYRENE (SORB FREE)...40 SOLTAMOX...8 SOMAVERT...45 SORINE...33 sotalol...33 SOTALOL AF...33 SOVALDI...9 spinosad...39 SPIRIVA WITH HANDIHALER...57 spironolactone...35 spironolacton-hydrochlorothiaz...35 SPORANOX...8 SPRINTEC (28)...53 SPRYCEL...8 SRONYX...53 SSD...37 stavudine...9 STIVARGA...8 STRATTERA...3 streptomycin...2 STRIBILD...9 STROMECTOL...2 SUCRAID...47 sucralfate...48 sulfacetamide sodium...55 sulfacetamide sodium (acne) 38 sulfacetamide-prednisolone..55 sulfadiazine...4 sulfamethoxazole-trimethoprim...4 SULFAMYLON...38 sulfasalazine...47 SULFAZINE EC...47 sulindac...25 sumatriptan...2 sumatriptan succinate...2 SUPRAX...0, SURMONTIL...32 SUSTIVA...9 SUTENT...8 SYLATRON...49 SYLVANT...8 SYMBICORT...57 SYMLINPEN SYMLINPEN SYNAGIS...9 SYNAREL...45 SYNERCID...2 SYNRIBO...8 SYPRINE...4 T TABLOID...8 tacrolimus...8 TAFINLAR...8, 9 TAMIFLU...9 tamoxifen...9 tamsulosin...58 TARCEVA...9 TARGRETIN...9 TASIGNA...9 TAZORAC...37 TAZTIA XT...35 TECFIDERA...22 TEFLARO... TEGRETOL XR...2 telmisartan...35 telmisartan-amlodipine...35 telmisartan-hydrochlorothiazid...35 temazepam...32 terazosin...35 terbinafine...8 terbutaline...57 terconazole...52 testosterone cypionate...45 testosterone enanthate...45 tetanus toxoid,adsorbed (pf).50 tetanus-diphtheria toxoids-td 50 tetracycline...4 THALOMID...9 theophylline...57 THIOLA...4 thioridazine...32 thiothixene...32 THYROLAR THYROLAR-/ THYROLAR-/ THYROLAR THYROLAR tiagabine...2 TIKOSYN...33 timolol maleate...35, 54 tinidazole...2 TIVICAY...9 tizanidine...22 tobramycin...54 tobramycin in % nacl..2 tobramycin in 0.9 % nacl...2 tobramycin sulfate...2 tobramycin-dexamethasone..55 tolazamide...44 tolbutamide...44 tolmetin...25 tolterodine...58 topiramate...2 TOPOSAR...9 topotecan...9 TORISEL...9 torsemide...35 TRACLEER...57 TRADJENTA...44 tramadol...25, 26 tramadol-acetaminophen...26 trandolapril...35 tranexamic acid...36, 52 TRANSDERM-SCOP...47 tranylcypromine...32 TRAVASOL 0 %...60 travoprost (benzalkonium)...55 trazodone...32 TREANDA...9 TRECATOR...2 TRELSTAR...9 TRELSTAR DEPOT...9 TRELSTAR LA...9 tretinoin...37 tretinoin (chemotherapy)...9 triamcinolone acetonide.39, 4, 42, 57 triamterene-hydrochlorothiazid...35 TRIDERM...39 trifluoperazine...32 trifluridine...54 TRI-LEGEST FE

72 TRILYTE WITH FLAVOR PACKETS...47 trimethoprim...4 TRINESSA (28)...53 TRI-PREVIFEM (28)...53 TRISENOX...9 TRI-SPRINTEC (28)...53 TRIVORA (28)...53 TROPHAMINE 0 %...60 TROPHAMINE 6%...60 trospium...58 TRUVADA...0 TWINRIX (PF)...50 TYGACIL...2 TYKERB...9 TYPHIM VI...50 TYSABRI...22 TYVASO...57 TYZEKA...0 TYZINE...4 U UCERIS...47 ULORIC...5 UNITHROID...46 ursodiol...47 UVADEX...37 V valacyclovir...0 VALCYTE...0 valproate sodium...2 valproic acid...2 valproic acid (as sodium salt)...2 valsartan-hydrochlorothiazide...35 vancomycin...4 VANDAZOLE...52 VAQTA (PF)...50 VARIVAX (PF)...50 VECAMYL...36 VECTIBIX...9 VELCADE...9 VELIVET TRIPHASIC REGIMEN (28)...54 venlafaxine...32 verapamil...35 VERIPRED VERSACLOZ...32 VESTURA (28)...54 VGO VGO VGO VICODIN...25 VICODIN ES...25 VICODIN HP...25 VICTRELIS...0 VIDEX 2 GRAM PEDIATRIC...0 VIIBRYD...32 VIMPAT...2 vinblastine...9 vincristine...9 vinorelbine...9 VIOKACE...47 VIRACEPT...0 VIRAMUNE XR...0 VIRAZOLE...0 VIREAD...0 VOLTAREN GEL...26 voriconazole...8 VOTRIENT...9 VPRIV...45 VYFEMLA (28)...54 W warfarin...36 water for irrigation, sterile...4 WELCHOL...36 X XALKORI...9 XARELTO...36 XENAZINE...22 XGEVA...5 XIFAXAN...2 XOLAIR...58 XTANDI...9 XULANE...52 XYREM...32 Y YERVOY...9 YF-VAX (PF)...50 Z zafirlukast...58 zaleplon...32 ZALTRAP...9 ZAMICET...25 ZANOSAR...9 ZAVESCA...45 ZELBORAF...9 ZEMPLAR...45 ZENATANE...37 ZENCHENT (28)...54 ZENCHENT FE...54 ZENPEP...47 ZENZEDI...32 ZETIA...36 ZIAGEN...0 zidovudine...0 ziprasidone hcl...32 ZIRGAN...54 zoledronic acid...45 zoledronic acid-mannitol-water...4 ZOLINZA...20 zolmitriptan...2 zolpidem...32 zonisamide...2 ZORTRESS...20 ZOSTAVAX (PF)...50 ZOVIA /35E (28)...54 ZOVIA /50E (28)...54 ZOVIRAX...38 ZUBSOLV...26 ZYCLARA...37 ZYKADIA...20 ZYTIGA...20 ZYVOX...3 7

73 Community HealthFirst MA Special Needs Plan (HMO SNP) 205 Pharmacy Directory This pharmacy directory was updated on 08/22/204. For more recent information or other questions, please contact Community Health Plan of Washington at or for TTY users, Dial 7--, 7 days a week, 8am 8pm or visit Introduction This booklet provides a list of Community HealthFirst MA Special Needs Plan s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Community HealthFirst MA Special Needs Plan s formulary. When this pharmacy directory refers to we, us, or our, it means Community Health Plan of Washington. When it refers to plan or our plan, it means Community HealthFirst MA Special Needs Plan. We call the pharmacies on this list our network pharmacies because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under our plan only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at nonnetwork pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of 0/2/204. For the most current list, please contact us. Our contact information appears on the front and back cover pages. You can get prescription drugs shipped to your home through our network mail order delivery program. For more information, please contact us or see the mail order section of this pharmacy directory. If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact us. 72

74 Can the list of network pharmacies change? Yes, our plan may add or remove pharmacies from our pharmacy directory. To get current information about Community HealthFirst MA Special Needs Plan network pharmacies in your area, please visit our web site at or call Customer Service. How do I find a Community HealthFirst MA Special Needs Plan network pharmacy in my area? You can visit our web site at or call Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7 days a week. Current members should call and prospective members should call (TTY Relay: Dial 7--). How do I fill a prescription at a network pharmacy? To fill your prescription at a network pharmacy, you must show your Community HealthFirst MA Special Needs Plan Member ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription (rather than paying just your copay). If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Evidence of Coverage or call our Customer Service. How do I fill a prescription through Community HealthFirst MA Special Needs Plan s mail-order pharmacy service? To get order forms and information about filling your prescriptions by mail, please call Please note that you must use our mail-order service. Prescription drugs that you get through any other mail-order service are not covered. You can use our plan s mail-order service to fill prescriptions for any drug that is on the formulary list. Our plan s mail-order service requires you to order at least a 30-day supply of the drug and no more than a 90-day supply. You are not required to use mail-order service to obtain an extended supply of maintenance medications. Instead, you have the option of using a retail pharmacy in our network to obtain a supply of maintenance medications. Some retail pharmacies may agree to accept the mail-order reimbursement rate for an extended supply of medications for up to 90 days per dispensing, which may result in no out-of-pocket payment difference to you. Other retail pharmacies may not agree to accept the mail-order reimbursement rate for an extended supply of medication. In this case, you will be responsible for the difference in price. Please look in the pharmacy directory below for retail pharmacies in our network at which you can obtain an extended supply of maintenance medications or call our Customer Service for more information. After you ve sent your order, you should receive your prescription within 4 days. If for some reason your order cannot be delivered within 4 days, a mail-order representative may contact you. For more information about mail-order, visit Community HealthFirst s web site at or call our Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7 days a week. Current members should call and prospective members should call (TTY Relay: Dial 7--). Filling prescriptions outside the network Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions filled at an out-of- network pharmacy. Before you fill your prescription in these situations, call Customer Service to see if there is a network pharmacy in your area where you can fill your prescription. If you must use an out-of-network pharmacy, you will generally have to 73 73

75 pay the full cost (rather than your normal share of the cost) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy as any amount you pay will help you qualify for catastrophic coverage. To learn how to submit a paper claim, please refer to the paper claims process described next. You will be allowed a total of three fills at an out-of-network pharmacy within a plan year. If you fill a prescription out-of- network, you will receive a message on your monthly Explanation of Benefits (EOB) that will state Non-network pharmacy. If you request a fourth fill at an out-of-network pharmacy, your request for coverage will be denied. If you feel that the out-of-network claim should have been covered, contact our Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7 days a week. Current members should call and prospective members should call (TTY Relay: Dial 7--). How do I submit a paper claim? When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription. To submit a paper claim, you must send a copy of the receipt for the prescription drugs from the pharmacy where you bought them and a completed Prescription Claim Form. Please send the completed Prescription Claim Form and the receipts to the following address: Express Scripts Attn: Med D Accts. PO Box 2858 Clinton, IA If you do not have a Prescription Claim Form visit our web site at or call Customer Service. Community HealthFirst MA Special Needs Plan Retail Pharmacies Offering Extended Supplies Medications You are not required to use mail-order service to obtain an extended supply of maintenance medications. Instead, you have the option of using a retail pharmacy in our network to obtain an extended supply of maintenance medications. Some retail pharmacies may agree to accept the mail-order reimbursement rate for an extended supply of medications for up to 90 days per dispensing, which may result in no out-of-pocket payment difference to you. Other retail pharmacies may not agree to accept the mail-order reimbursement rate for an extended supply of medication. In this case, you will be responsible for the difference in price. In the pharmacy directory below, you will find identified those retail pharmacies in our network that offer extended supplies of maintenance medications. For more information For more detailed information about your Community HealthFirst prescription drug coverage, please review the Evidence of Coverage and Community HealthFirst s formulary. If you have questions about Community HealthFirst, please visit our web site at or call Customer Service during the hours of 8:00 a.m. to 8:00 p.m., 7 days a week. Current members should call and prospective members should call (TTY Relay: Dial 7--) of

76 Pharmacy Listing Table of Contents Retail Pharmacies page 82 Mail-Order Pharmacies page 4 Home Infusion Pharmacies page 42 Long Term Care Pharmacies page 44 Indian Health Service/Tribal/ Urban Indian Health Program Pharmacies page 50 75

77 ADAMS COUNTY...82 OTHELLO...82 RITZVILLE...82 ASOTIN COUNTY...82 CLARKSTON...82 BENTON COUNTY...82 BENTON CITY...82 KENNEWICK...82 PROSSER...83 RICHLAND...83 WEST RICHMOND...84 CHELAN COUNTY...84 CASHMERE...84 CHELAN...84 LEAVENWORTH...84 WENATCHEE...84 CLALLAM COUNTY...84 FORKS...84 PORT ANGELES...84 SEQUIM...85 CLARK COUNTY...85 BATTLE GROUND...85 CAMAS...85 ORCHARDS...86 VANCOUVER...86 WASHOUGAL...88 COLUMBIA COUNTY...88 DAYTON...88 COWLITZ COUNTY...88 CASTLE ROCK...88 KALAMA...88 KELSO...88 LONGVIEW...89 WOODLAND...89 DOUGLAS COUNTY...89 BRIDGEPORT...89 EAST WENATCHEE...89 WENATCHEE

78 FERRY COUNTY...90 REPUBLIC...90 FRANKLIN COUNTY...90 CONNELL...90 PASCO...90 GARFIELD COUNTY...90 POMEROY...90 GRANT COUNTY...90 EPHRATA...90 GRAND COULEE...9 MATTAWA...9 MOSES LAKE...9 QUINCY...9 GRAYS HARBOR COUNTY...9 ABERDEEN...9 ELMA...9 HOQUIAM...9 OCEAN SHORES...92 WESTPORT...92 ISLAND COUNTY...92 CAMANO ISLAND...92 CLINTON...92 COUPEVILLE...92 FREELAND...92 OAK HARBOR...92 JEFFERSON COUNTY...92 PORT HADLOCK...92 PORT TOWNSEND...92 KING COUNTY...93 AUBURN...93 BELLEVUE...93 BOTHELL...94 BURIEN...94 COVINGTON...95 DES MOINES...95 DUVALL...95 ENUMCLAW...95 FEDERAL WAY...96 ISSAQUAH...96 KENMORE...97 KENT...97 KIRKLAND

79 MAPLE VALLEY...99 MERCER ISLAND...99 NEWCASTLE...99 NORMANDY PARK...99 NORTH BEND...99 REDMOND...99 RENTON...00 SAMMAMISH...0 SEATAC...0 SEATTLE...0 SHORELINE...07 SNOQUALMIE...08 TUKWILA...08 VASHON...08 WOODINVILLE...08 KITSAP COUNTY...09 BAINBRIDGE ISLAND...09 BREMERTON...09 KINGSTON...0 PORT ORCHARD...0 POULSBO...0 SILVERDALE... KITTITAS COUNTY... CLE ELUM... ELLENSBURG... KLICKITAT COUNTY... WHITE SALMON... LEWIS... CENTRALIA... CHEHALIS...2 MORTON...2 WINLOCK...2 LINCOLN COUNTY...2 DAVENPORT...2 BELFAIR...2 SHELTON...2 OKANOGAN COUNTY...3 BREWSTER...3 OKANOGAN...3 OMAK...3 TONASKET...3 TWISP

80 PACIFIC COUNTY...3 LONG BEACH...3 OCEAN PARK...3 RAYMOND...3 SOUTH BEND...3 PEND OREILLE COUNTY...3 NEWPORT...3 PIERCE COUNTY...3 AUBURN...3 BONNEY LAKE...4 BUCKLEY...4 DUPONT...4 EDGEWOOD...4 FIRCREST...4 GIG HARBOR...4 GRAHAM...5 LAKEWOOD...5 MILTON...5 ORTING...6 PUYALLUP...6 SPANAWAY...7 SUMNER...7 TACOMA...7 UNIVERSITY PLACE...9 SAN JUAN COUNTY...20 EASTSOUND...20 FRIDAY HARBOR...20 LOPEZ ISLAND...20 SKAGIT COUNTY...20 ANACORTES...20 BURLINGTON...20 CONCRETE...20 LA CONNER...2 MOUNT VERNON...2 SEDRO WOOLLEY...2 SKAMANIA COUNTY...2 STEVENSON...2 SNOHOMISH COUNTY...2 ARLINGTON...2 BOTHELL...22 DARRINGTON...22 EDMONDS...22 EVERETT

81 GRANITE FALLS...25 LAKE STEVENS...25 LYNNWOOD...25 MARYSVILLE...26 MILL CREEK...26 MOUNTLAKE TERRACE...27 MUKILTEO...27 SNOHOMISH...27 STANWOOD...28 SULTAN...28 TULALIP...28 WOODINVILLE...28 SPOKANE COUNTY...28 AIRWAY HEIGHTS...28 CHENEY...28 DEER PARK...28 FAIRFIELD...28 LIBERTY LAKE...28 MEAD...29 MEDICAL LAKE...29 MILLWOOD...29 SPOKANE...29 SPOKANE VALLEY...32 VERADALE...33 STEVENS COUNTY...33 CHEWELAH...33 COLVILLE...33 KETTLE FALLS...33 NINE MILE FALLS...33 THURSTON COUNTY...33 LACEY...33 OLYMPIA...34 TENINO...34 TUMWATER...34 YELM...35 WAHKIAKUM COUNTY...35 CATHLAMET...35 WALLA WALLA...35 WHATCOM COUNTY...36 BELLINGHAM...36 BLAINE...37 EVERSON...37 LYNDEN...37 SUMAS

82 WHITMAN COUNTY...37 COLFAX...37 GARFIELD...37 PULLMAN...37 SAINT JOHN...38 TEKOA...38 YAKIMA COUNTY...38 GRANDVIEW...38 SELAH...38 SUNNYSIDE...38 TOPPENISH...38 UNION GAP...38 WAPATO...38 YAKIMA

83 Pharmacies noted with a * offer a 90 day supply. Retail Pharmacies ADAMS COUNTY OTHELLO OTHELLO FAMILY CLINIC 40 E MAIN ST OTHELLO, WA (509) WAL-MART * 860 E MAIN ST OTHELLO, WA (509) RITZVILLE RITZVILLE DRUG * 209 W MAIN AVE RITZVILLE, WA 9969 (509) ASOTIN COUNTY CLARKSTON BI-MART 5 3RD ST CLARKSTON, WA (509) CHAS-WASEM * 800 6TH ST CLARKSTON, WA (509) CLARKSTON HEIGHTS 29 5TH AVE CLARKSTON, WA (509) COSTCO * 30 FIFTH ST CLARKSTON, WA (509) OWL TRI-STATE 275 HIGHLAND AVE CLARKSTON, WA (509) SAVON 400 BRIDGE ST CLARKSTON, WA (509) WAL-MART * 306 5TH ST CLARKSTON, WA (509) WASEM'S DRUG * 800 6TH ST CLARKSTON, WA (509) BENTON COUNTY BENTON CITY LOGAR 55 9TH ST STE A BENTON CITY, WA (509) KENNEWICK ALBERTSON'S * 5204 W CLEARWATER KENNEWICK, WA (509) COLUMBIA BASIN HEMATOLOGY * 7360 W DESCHUTES AVE KENNEWICK, WA (509) COSTCO * 8505 W GAGE BLVD KENNEWICK, WA (509) FRED MEYER 28 W 0TH AVE KENNEWICK, WA (509) MEDICAL MALL 52 N YOUNG ST KENNEWICK, WA (509)

84 90 N STEPTOE ST KENNEWICK, WA (509) W 2825 KENNEWICK AVE KENNEWICK, WA (509) SHOPKO PHARMACY* 867 N COLUMBIA CENTER BLVD KENNEWICK, WA (509) TARGET 60 N COLUMBIA CENTER BLVD KENNEWICK, WA (509) W 27TH AVE KENNEWICK, WA (509) W CLEARWATER AVE KENNEWICK, WA (509) WAL-MART * 2720 S QUILLAN ST KENNEWICK, WA (509) YOKES 40 W 27TH AVE KENNEWICK, WA (509) PROSSER ELFERS-LYON 820 MEMORIAL ST STE 2 PROSSER, WA (509) RICHLAND ALBERTSON'S * 320 LEE BLVD RICHLAND, WA (509) ALBERTSON'S * 690 GAGE BLVD RICHLAND, WA (509) DENSOW'S 0 WRIGHT AVE RICHLAND, WA (509) FRED MEYER 0 WELLSIAN WAY RICHLAND, WA (509) MALLEYS COMPOUNDING 906 GEORGE WASHINGTON WAY RICHLAND, WA (509) LEE BLVD RICHLAND, WA (509) GEORGE WASHINGTON WAY RICHLAND, WA (509) GEORGE WASHINGTON WAY RICHLAND, WA (509) GEORGE WASHINGTON WAY RICHLAND, WA (509) SWIFT BLVD STE 60 RICHLAND, WA (509) GAGE BLVD RICHLAND, WA (509) WAL-MART * 280 DUPORTAIL ST RICHLAND, WA (509) YOKES * 455 ENGLEWOOD DR RICHLAND, WA (509)

85 WEST RICHMOND YOKES 40 BOMBING RANGE RD WEST RICHMOND, WA (509) CHELAN COUNTY CASHMERE DOANE'S VALLEY 9 COTTAGE AVE CASHMERE, WA 9885 (509) CHELAN LAKE CHELAN 223 E JOHNSON AVE CHELAN, WA 9886 (509) W MANSON RD CHELAN, WA 9886 (509) WAL-MART * 08 APPLE BLOSSOM DR CHELAN, WA 9886 (509) LEAVENWORTH 6 RIVERBEND DR LEAVENWORTH, WA (509) VILLAGE PHARMACY* 85 FRONT ST LEAVENWORTH, WA (509) WENATCHEE ALBERTSON'S * 28 N MILLER ST WENATCHEE, WA 9880 (509) CENTRAL WASHINGTON HOSP PHCY * 933 RED APPLE RD STE A WENATCHEE, WA 9880 (509) COLUMBIA VALLEY COMM H PHCY * 600 ORONDO AVE STE WENATCHEE, WA 9880 (509) N MILLER ST WENATCHEE, WA 9880 (509) N MILLER ST WENATCHEE, WA 9880 (509) N MILLER ST WENATCHEE, WA 9880 (509) WAL-MART * 2000 N WENATCHEE AVE WENATCHEE, WA 9880 (509) WENATCHEE CLINIC 820 N CHELAN AVE WENATCHEE, WA 9880 (509) CLALLAM COUNTY FORKS CHINOOK PHARMACY S FORKS AVE FORKS, WA 9833 (360) PORT ANGELES ALBERTSON'S * 4 E LAURIDSEN BLVD PORT ANGELES, WA (360)

86 JIM'S 424 2ND ST E PORT ANGELES, WA (360) S LINCOLN ST PORT ANGELES, WA (360) E ST ST STE 0 PORT ANGELES, WA (360) E 3RD ST PORT ANGELES, WA (360) E HIGHWAY 0 PORT ANGELES, WA (360) E FRONT ST PORT ANGELES, WA (360) WAL-MART * 34 E KOLONELS WAY PORT ANGELES, WA (360) SEQUIM COSTCO * 955 W WASHINGTON ST SEQUIM, WA (360) QFC 990 E WASHINGTON ST BLDG B SEQUIM, WA (360) W WASHINGTON ST SEQUIM, WA (360) W WASHINGTON ST BLDG F SEQUIM, WA (360) W WASHINGTON ST SEQUIM, WA (360) CLARK COUNTY BATTLE GROUND ALBERTSON'S * 208 W MAIN ST BATTLE GROUND, WA (360) FRED MEYER 40 NW 2TH AVE BATTLE GROUND, WA (360) W MAIN ST BATTLE GROUND, WA (360) W MAIN ST STE 0 BATTLE GROUND, WA (360) WAL-MART * 20 SW 3TH AVE BATTLE GROUND, WA (360) CAMAS COSTCO * 960 SE ST ST CAMAS, WA (360) NE 3RD AVE CAMAS, WA (360) NE 3RD AVE CAMAS, WA (360)

87 ORCHARDS BI-MART PHARMACY 92 4TH PLAIN BLVD NE ORCHARDS, WA (360) VANCOUVER ALBERTSON'S * 4300 NE 20TH AVE VANCOUVER, WA (360) BI-MART PHARMACY 260 FALK RD VANCOUVER, WA (360) COSTCO * 6720 NE 84TH ST VANCOUVER, WA (360) FAMILY WELLNESS CENTER PC * 000 SE TECH CTR DR STE 20 VANCOUVER, WA (360) FRED MEYER 325 SE MILL PLAIN BLVD VANCOUVER, WA (360) FRED MEYER * 74 NE 7TH AVE VANCOUVER, WA (360) FRED MEYER 6600 SE MCGILLIVRAY BLVD VANCOUVER, WA (360) FRED MEYER * 7700 NE HIGHWAY 9 VANCOUVER, WA (360) FRED MEYER 800 NE TENNEY RD VANCOUVER, WA (360) HI-SCHOOL PHARMACY 6926 NE FOURTH PLAIN BLVD VANCOUVER, WA 9866 (360) LEGACY SALMON CREEK APOTHECARY* 22 NE 39TH ST STE 30 VANCOUVER, WA (360) MILL PLAIN MEDICAL AND PHCY * 864 E MILL PLAIN BLVD VANCOUVER, WA (360) OLYMPIC DRUG * 3898 NE 28TH ST VANCOUVER, WA (360) PACIFIC NW SPECIALTY 380 MAIN ST STE A VANCOUVER, WA (360) PEACE HEALTH SOUTHWEST PHCY * 420 MOTHER JOSEPH PL VANCOUVER, WA (360) PHSW PHARMACY AT MEDICAL CTR * 420 NE MOTHER JOSEPH PL VANCOUVER, WA (360) QFC 3505 SE 92ND AVE VANCOUVER, WA (360)

88 2800 NE 62ND AVE VANCOUVER, WA (360) SE 3RD WAY VANCOUVER, WA (360) NE 63RD ST VANCOUVER, WA 9866 (360) NE 2TH AVE VANCOUVER, WA (360) E MILL PLAIN BLVD VANCOUVER, WA 9866 (360) NE 76TH ST VANCOUVER, WA (360) MAIN ST VANCOUVER, WA (360) SE MILL PLAIN BLVD VANCOUVER, WA (360) NE HIGHWAY 99 VANCOUVER, WA (360) NE 8ST ST VANCOUVER, WA (360) TARGET 880 NE HAZEL DELL AVE VANCOUVER, WA (360) TARGET 6200 SE MILL PLAIN BLVD VANCOUVER, WA (360) THE VANCOUVER CLINIC * 50 SE 72ND AVE VANCOUVER, WA (360) THE VANCOUVER CLINIC PHCY * 2525 NE 39TH ST VANCOUVER, WA (360) VANCOUVER CLINIC 700 NE 87TH AVE VANCOUVER, WA (360) NE 62ND AVE VANCOUVER, WA (360) NE 4TH AVE VANCOUVER, WA (360) NE ANDERSON RD VANCOUVER, WA 9866 (360) SE MILL PLAIN BLVD VANCOUVER, WA (360)

89 252 MAIN ST VANCOUVER, WA (360) NE HIGHWAY 99 VANCOUVER, WA (360) E MILL PLAIN BLVD VANCOUVER, WA (360) NE 62ND AVE BLDG C VANCOUVER, WA (360) NE 63RD ST VANCOUVER, WA 9866 (360) NE HIGHWAY 99 VANCOUVER, WA (360) WAL-MART * 430 SE 92ND AVE VANCOUVER, WA (360) WAL-MART * 220 GRAND BLVD VANCOUVER, WA 9866 (360) WAL-MART * 7809 NE VANCOUVER PLAZA DR VANCOUVER, WA (360) WAL-MART * 22E NE 04TH AVE VANCOUVER, WA (360) WAL-MART * 9000 NE HIGHWAY 99 VANCOUVER, WA (360) WASHOUGAL BI-MART PHARMACY 3003 ADDY ST WASHOUGAL, WA 9867 (360) EVERGREEN BLVD STE 4 WASHOUGAL, WA 9867 (360) * 3307 EVERGREEN WAY STE 5 WASHOUGAL, WA 9867 (360) COLUMBIA COUNTY DAYTON ELK DRUG 76 E MAIN ST DAYTON, WA (509) COWLITZ COUNTY CASTLE ROCK CASTLE ROCK 7 ST AVE SW CASTLE ROCK, WA 986 (360) KALAMA GODFREYS 270 N ST ST KALAMA, WA (360) KELSO L J'S FURNESS DRUG* 4 S PACIFIC AVE KELSO, WA (360)

90 230 KELSO DR KELSO, WA (360) THREE RIVERS DR KELSO, WA (360) TARGET 205 THREE RIVERS DR KELSO, WA (360) LONGVIEW FRED MEYER 384 OCEAN BEACH WAY LONGVIEW, WA (360) PEACEHEALTH ST JOHN MED CTR * 65 DELAWARE ST LONGVIEW, WA (360) OCEAN BEACH HWY LONGVIEW, WA (360) TH AVE LONGVIEW, WA (360) OCEAN BEACH HWY LONGVIEW, WA (360) WAL-MART * 375 OCEAN BEACH HWY LONGVIEW, WA (360) WAL-MART * 540 7TH AVE LONGVIEW, WA (360) WOODLAND HI-SCHOOL 365 LEWIS RIVER RD WOODLAND, WA (360) PACIFIC AVE WOODLAND, WA (360) WAL-MART * 486 DIKE ACCESS RD WOODLAND, WA (360) DOUGLAS COUNTY BRIDGEPORT GROSS DRUG * 2520 FOSTER CREEK AVE BRIDGEPORT, WA 9883 (509) EAST WENATCHEE BI-MART 780 GRANT RD EAST WENATCHEE, WA (509) E WENATCHEE FOOD PAVILION PHCY * 35 VALLEY MALL PKWY EAST WENATCHEE, WA (360) GRANT RD EAST WENATCHEE, WA (509) WENATCHEE 470 GRANT RD WENATCHEE, WA (509)

91 COSTCO * 375 HIGHLINE DR S WENATCHEE, WA (509) FRED MEYER GRANT BLVD WENATCHEE, WA (509) FERRY COUNTY REPUBLIC REPUBLIC DRUG STORE 6 N CLARK AVE REPUBLIC, WA 9966 (509) FRANKLIN COUNTY CONNELL CONNELL FAMILY CLINIC 05 COLUMBIA AVE CONNELL, WA (509) PASCO FIESTA 5 S 0TH AVE PASCO, WA 9930 (509) LOURDES WEST PASCO 7425 WRIGLEY DR STE 04 PASCO, WA 9930 (509) MEDICINE SHOPPE 2 W COURT ST PASCO, WA 9930 (509) N 4TH AVE PASCO, WA 9930 (509) N 20TH AVE PASCO, WA 9930 (509) TCCH 55 W COURT ST PASCO, WA 9930 (509) N 4TH AVE STE 00 PASCO, WA 9930 (509) W COURT ST PASCO, WA 9930 (509) RD 68 PASCO, WA 9930 (509) WAL-MART * 4820 N ROAD 68 PASCO, WA 9930 (509) YOKES 4905 N ROAD 68 PASCO, WA 9930 (509) GARFIELD COUNTY POMEROY POMEROY 764 MAIN STREET POMEROY, WA (509) GRANT COUNTY EPHRATA 250 BASIN ST SW EPHRATA, WA (509) BASIN ST SW EPHRATA, WA (509) WAL-MART * 399 SE BLVD EPHRATA, WA (509)

92 GRAND COULEE 0 GRAND COULEE HWY GRAND COULEE, WA 9933 (509) MATTAWA WFHC PHARMACY 60 GOVERNMENT WAY MATTAWA, WA (509) MOSES LAKE PIONEER MED CENTER 550 S PIONEER WAY STE 05 MOSES LAKE, WA (509) S PIONEER WAY MOSES LAKE, WA (509) S PIONEER WAY MOSES LAKE, WA (509) SOUTHGATE 2709 W BROADWAY AVE MOSES LAKE, WA (509) E BROADWAY AVE MOSES LAKE, WA (509) WAL-MART * 005 N STRATFORD RD MOSES LAKE, WA (509) QUINCY SHOPKO PHARMACY* 0 F ST QUINCY, WA (509) GRAYS HARBOR COUNTY ABERDEEN ABERDEEN HEALTH MART 82 SUMNER AVE STE H ABERDEEN, WA (360) CITY CENTER DRUG * 08 E WISHKAH ST ABERDEEN, WA (360) E WISHKAH ST ABERDEEN, WA (360) W HERON ST ABERDEEN, WA (360) SWANSON OWL 7 N BOONE ST ABERDEEN, WA (360) WAL-MART * 909 E WISHKAH ST ABERDEEN, WA (360) ELMA ELMA HEALTH MART 22 W MAIN ST ELMA, WA 9854 (360) HOQUIAM CROWN DRUG * 2544 SIMPSON AVE HOQUIAM, WA (360) HARBOR DRUG * 36 8TH ST HOQUIAM, WA (360) SIMPSON AVE HOQUIAM, WA (360)

93 OCEAN SHORES OCEAN SHORES 72 W CHANCE A LA MER NW OCEAN SHORES, WA (360) WESTPORT ALBERTSON'S * TWIN HARBOR DRUG* 450 SW ERIE ST 733 N MONTESANO OAK HARBOR, WA ST WESTPORT, WA (360) (360) ISLAND DRUG * ISLAND COUNTY 230 SE PIONEER WAY OAK HARBOR, WA CAMANO ISLAND (360) MARKS CAMANO KMART 370 NE CAMANO DR 3265 SR 20 STE 6 OAK HARBOR, WA CAMANO ISLAND, WA (360) (360) CLINTON ISLAND DRUG * 042 STATE ROUTE 525 CLINTON, WA (360) COUPEVILLE LINDS COUPVILLE 40 N MAIN ST COUPEVILLE, WA (360) FREELAND LIND'S FREELAND 609 E MAIN ST FREELAND, WA (360) OAK HARBOR 3645 SR 20 OAK HARBOR, WA (360) SAAR'S MARKETPLACE FOOD * 3299 STATE RTE 20 OAK HARBOR, WA (360) STATE RTE 20 OAK HARBOR, WA (360) WAL-MART * 250 SW ERIE ST OAK HARBOR, WA (360) JEFFERSON COUNTY PORT HADLOCK QFC 890 IRONDALE RD PORT HADLOCK, WA (360) TRI-AREA PHARMACY* 65 OAK BAY RD PORT HADLOCK, WA (360) PORT TOWNSEND DONS 5 WATER ST PORT TOWNSEND, WA (360) W SIMS WAY PORT TOWNSEND, WA (360)

94 KING COUNTY AUBURN FRANCISCAN PHARMACY AUBURN* 205 0TH ST NE AUBURN, WA (253) FRED MEYER 80 AUBURN WAY N AUBURN, WA (253) HEALTHPOINT AUBURN PHARMACY* 26 AUBURN AVE STE 04 AUBURN, WA (253) PECKENPAUGH DRUG * 23 E MAIN ST AUBURN, WA (253) AUBURN WAY N AUBURN, WA (253) AUBURN WAY S AUBURN, WA (253) AUBURN WAY S AUBURN, WA (253) SAM'S CLUB * 0 SUPERMALL WAY STE 275 AUBURN, WA 9800 (253) TOP FOOD AND DRUG* 702 AUBURN WAY N AUBURN, WA (253) HARVEY RD AUBURN, WA (253) AUBURN WAY S AUBURN, WA (253) WAL-MART * 762 OUTLET COLLECTION DR SW AUBURN, WA 9800 (253) BELLEVUE BARTELL DRUGS * 3620 FACTORIA BLVD SE BELLEVUE, WA (425) BARTELL DRUGS * 06 NE 8TH ST BELLEVUE, WA (425) BARTELL DRUGS * 99 NE 8TH ST BELLEVUE, WA (425) BARTELL DRUGS * TH AVE NE BELLEVUE, WA (425) BELLEGROVE 200 2TH AVE NE STE A00 BELLEVUE, WA (425) EVERGREEN INTEGRATIVE MEDICINE * 520 NE 20TH ST BELLEVUE, WA (425) FRED MEYER TH NE BELLEVUE, WA (425) LAKEMONT 4935 LAKEMONT BLVD SE BELLEVUE, WA (425) MEDIART FAMILY CLINIC * TH AVE NE STE 0 BELLEVUE, WA (425) MEDICAL ARTS ASSOCIATES PS * 380 2TH AVE NE STE 00 BELLEVUE, WA (425)

95 MICHAEL K WOO ND * TH AVE NE STE 03 BELLEVUE, WA (425) O'HANA WELLNESS CENTER * TH AVE NE STE 03 BELLEVUE, WA (425) PHARMACY PLUS * TH AVE NE STE 40 BELLEVUE, WA (425) QFC 2636 BELLEVUE WAY NE BELLEVUE, WA (425) QFC 50 45TH PL SE BELLEVUE, WA (425) QFC 3550 FACTORIA BLVD SE BELLEVUE, WA (425) SE 38TH ST BELLEVUE, WA (425) TH AVE NE BELLEVUE, WA (425) FACTORIA MALL SE BELLEVUE, WA (425) TH AVE NE BELLEVUE, WA (425) BELLEVUE WAY BELLEVUE, WA (425) SEATTLE CHILDRENS HOSPITAL * 500 6TH AVE NE BELLEVUE, WA (206) TH AVE NE BELLEVUE, WA (425) TH AVE NE STE 05 BELLEVUE, WA (425) NE 24TH ST BELLEVUE, WA (425) WAL-MART * 5063 MAIN ST BELLEVUE, WA (425) WAL-MART * 2620 SE 4ST PL BELLEVUE, WA (425) WASHINGTON CTR FOR PAIN MGMT * 900 6TH AVE NE STE 20 BELLEVUE, WA (425) BOTHELL HEALTHPOINT BOTHELL PHARMACY* 044 BEARDSLEE BLVD BOTHELL, WA 980 (425) QFC 892 BOTHELL WAY NE BOTHELL, WA 980 (425) BOTHELL WAY NE BOTHELL, WA 980 (425) BURIEN ALBERTSON'S * 2725 ST AVE S BURIEN, WA 9868 (206) BARTELL DRUGS * 490 4TH AVE SW BURIEN, WA 9866 (206)

96 0 SW 48TH ST BURIEN, WA 9866 (206) THREE MOON CLINIC* 800 SW 52ND ST STE A BURIEN, WA 9866 (206) AMBAUM BLVD SW BURIEN, WA 9866 (206) COVINGTON COSTCO * COVINGTON WAY SE COVINGTON, WA (253) COVINGTON MULTICARE CLINIC * 7700 SE 272ND ST STE 00 COVINGTON, WA (253) SE 272ND ST COVINGTON, WA (253) WAL-MART * 7432 SE 270TH PL COVINGTON, WA (253) DES MOINES BARTELL DRUGS * PACIFIC HWY S DES MOINES, WA 9898 (253) NATUROPATHIC MEDICINE * 2205 MARINE VIEW DR S DES MOINES, WA 9898 (206) PACIFIC HWY S DES MOINES, WA 9898 (206) PACIFIC HWY S DES MOINES, WA 9898 (206) DUVALL DUVALL FAMILY DRUGS * 5602 MAIN ST NE DUVALL, WA 9809 (425) MAIN ST NE DUVALL, WA 9809 (425) ENUMCLAW JIM'S 2820 GRIFFIN AVE STE 02 ENUMCLAW, WA (360) PLATEAU COMMUNITY 302 GRIFFIN AVE ENUMCLAW, WA (360) QFC 009 MONROE ST ENUMCLAW, WA (360) ROOSEVELT AVE ENUMCLAW, WA (360) ROOSEVELT AVE E ENUMCLAW, WA (360) ND ST ENUMCLAW, WA (360)

97 FEDERAL WAY ALBERTSON'S * 3009 PACIFIC HWY S FEDERAL WAY, WA (253) COSTCO * 3500 ENCHANTED PKWY S FEDERAL WAY, WA (253) FEDERAL WAY 3350 ST WAY S FEDERAL WAY, WA (253) FRANCISCAN PHARMACY FIRST AVE * ST AVE S FEDERAL WAY, WA (253) FRED MEYER ST AVE SW FEDERAL WAY, WA (253) HEALTHPOINT FEDERAL WAY PHCY* TH PL S FEDERAL WAY, WA (253) HIGHLAND 3260 PACIFIC HWY S STE 0 FEDERAL WAY, WA (253) ONURI TH AVE S STE B STE 2 FEDERAL WAY, WA (253) SW 336TH ST FEDERAL WAY, WA (253) PACIFIC HWY S FEDERAL WAY, WA (253) S 320TH ST FEDERAL WAY, WA (253) TARGET 220 S COMMONS FEDERAL WAY, WA (253) MILITARY RD S FEDERAL WAY, WA (253) HOYT RD SW FEDERAL WAY, WA (253) WAL-MART * TH AVE S FEDERAL WAY, WA (253) WAL-MART * 900 S 34TH ST FEDERAL WAY, WA (253) ISSAQUAH BARTELL DRUGS * 5700 E LAKE SAMMAMISH PKWY ISSAQUAH, WA (425) COSTCO * 80 0TH AVE NW ISSAQUAH, WA (425) FRED MEYER 600 E LAKE SAMMAMISH PKWY ISSAQUAH, WA (425) MEDICAL CENTER 450 NW GILMAN BLVD STE 07 ISSAQUAH, WA (425)

98 QFC 4560 KLAHANIE DR SE ISSAQUAH, WA (425) NW GILMAN BLVD ISSAQUAH, WA (425) HIGHLANDS DR NE ISSAQUAH, WA (425) NW GILMAN BLVD ISSAQUAH, WA (425) SWEDISH ISSAQUAH RETAIL PHCY * 75 NE BLAKELY DR ISSAQUAH, WA (425) TARGET 755 NW GILMAN BLVD ISSAQUAH, WA (425) E LAKE SAMMAMISH PKWY ISSAQUAH, WA (425) KENMORE OSTROM DRUG AND GIFT * 644 NE BOTHELL WAY KENMORE, WA (425) NE 68TH AVE KENMORE, WA (425) NE BOTHELL WAY KENMORE, WA (425) KENT A AND H PHARMACEUTICAL SVCS 60 W MEEKER ST STE 20 KENT, WA (253) BARTELL DRUGS * 2946 SE KENT KANGLEY RD KENT, WA (253) FRED MEYER PACIFIC HWY S KENT, WA 9803 (253) FRED MEYER 6735 SE 272ND ST KENT, WA (253) FRED MEYER 020 SE 240TH ST KENT, WA 9803 (253) HEALTHPOINT KENT 403 E MEEKER ST STE 300 KENT, WA (253) PROPAC PHARMACY* 702 S 220TH ST KENT, WA (855) PACIFIC HWY S KENT, WA (253) SE 256TH ST KENT, WA (253) WASHINGTON AVE N KENT, WA (253) ND SE KENT, WA (253)

99 TH AVE SE KENT, WA 9803 (253) SE KENT KANGLEY HWY KENT, WA 9803 (253) WASHINGTON AVE S KENT, WA (253) TARGET TH AVE SE KENT, WA 9803 (253) TOP FOOD AND DRUG* TH AVE SE KENT, WA (253) UNITED CARE 8230 E VALLEY HWY STE 88 KENT, WA (206) UNITED CARE PHARMACY 8230 E VALLEY HWY KENT, WA (425) TH AVE SE KENT, WA (253) ND AVE SE KENT, WA (253) KIRKLAND ASSURED PHARMACY* TH AVE NE KIRKLAND, WA (425) BARTELL DRUGS * ND AVE NE KIRKLAND, WA (425) BARTELL DRUGS * TH AVE NE KIRKLAND, WA (425) BARTELL DRUGS * 430 JUANITA DR NE KIRKLAND, WA (425) BARTELL DRUGS * 0625 NE 68TH ST KIRKLAND, WA (425) COSTCO * TH AVE NE KIRKLAND, WA (425) EVERGREEN 29 20TH AVE NE KIRKLAND, WA (425) EVERGREEN PROF CTR 2303 NE 30TH LN STE 20 KIRKLAND, WA (425) FRED MEYER TH AVE NE KIRKLAND, WA (425) INTEGRATIVE FOOT AND ANKLE CTR * ST WAY NE STE 204 KIRKLAND, WA (425) PACMED CLINIC PHARMACY 290 TOTEM LAKE BLVD NE KIRKLAND, WA (425) QFC 2 PARK PL KIRKLAND, WA (425) QFC 224 NE 24TH ST KIRKLAND, WA (425)

100 9820 NE 32ND ST KIRKLAND, WA (425) TOTEM LAKE BLVD KIRKLAND, WA (425) TH AVE NE KIRKLAND, WA (425) NE 37TH AVE KIRKLAND, WA (425) TH ST NE KIRKLAND, WA (425) TH AVE NE KIRKLAND, WA (425) NE 85TH ST KIRKLAND, WA (425) MAPLE VALLEY BARTELL DRUGS * 227 SE 237TH ST MAPLE VALLEY, WA (425) FRED MEYER MAPLE VALLEY BLACK MAPLE VALLEY, WA (425) BLACK DIAMOND RD SE MAPLE VALLEY, WA (425) MERCER ISLAND ALBERTSON'S * TH AVE SE MERCER ISLAND, WA (206) SE 78TH AVE MERCER ISLAND, WA (206) SE 68TH ST MERCER ISLAND, WA (206) SE 27TH ST STE 00 MERCER ISLAND, WA (206) NEWCASTLE BARTELL DRUGS * 6939 COAL CREEK PKWY SE NEWCASTLE, WA (425) NORMANDY PARK ACCESS 7833 ST AVE S STE C NORMANDY PARK, WA 9848 (206) NORTH BEND BARTELL DRUGS * 248 BENDIGO BLVD S NORTH BEND, WA (425) QFC 460 E NORTHBEND WAY NORTH BEND, WA (425) SW MOUNT BLVD NORTH BEND, WA (425) REDMOND ALBERTSON'S * TH AVE NE REDMOND, WA (425)

101 ALPINE INTEGRATED MEDICINE * NE MARKETPLACE DR REDMOND, WA (425) BARTELL DRUGS * ST AVE NE REDMOND, WA (425) BARTELL DRUGS * TH AVE NE REDMOND, WA (425) FRED MEYER 7667 NE 76TH ST REDMOND, WA (425) PHARMACA INTEGRATIVE 5840 REDMOND WAY REDMOND, WA (425) QFC ST AVE NE REDMOND, WA (425) NE 24TH ST REDMOND, WA (425) REDMOND WAY REDMOND, WA (425) TH AVE NE REDMOND, WA (425) TARGET 7700 NE 76TH ST REDMOND, WA (425) RENTON ALBERTSON'S * 425 SE PETROVITSKY RD RENTON, WA (425) BARTELL DRUGS * 4700 NE 4TH ST RENTON, WA (425) BARTELL DRUGS * TH SE RENTON, WA (425) FRED MEYER TH AVE SE RENTON, WA (425) FRED MEYER 365 RENTON CENTER WAY SW RENTON, WA (425) HEALTHPOINT CENTRAL FILL PHCY * 947 POWELL AVE SW RENTON, WA (877) JOLLY'S PHARMACY 42 SW 43RD ST STE 20 RENTON, WA (425) LAURA J HIEB ND * 304 MAIN AVE S STE 20 RENTON, WA (425) PACMED CLINIC PHARMACY 60 S CARR RD STE 00 RENTON, WA (425) PAIN ASSOCIATES OF WASHINGTON * 4300 TALBOT RD S STE 200 RENTON, WA (425) READY MEDS 42 SW 43RD ST STE 20 RENTON, WA (425) NE SUNSET BLVD RENTON, WA (425)

102 60 S GRADY WAY STE P RENTON, WA (425) TH ST NE RENTON, WA (425) S 3RD ST RENTON, WA (425) COAL CREEK PKWY SE RENTON, WA (425) SAM'S CLUB * 90 S GRADY WAY RENTON, WA (425) SUNSET PLAZA 388 NE SUNSET BLVD RENTON, WA (425) TARGET 25 LANDING WAY RENTON, WA (425) THE PRESCRIPTION PAD 395 TALBOT RD S RENTON, WA (425) THE PRESCRIPTION PAD 400 S 43RD ST RENTON, WA (425) NE 4TH ST RENTON, WA (425) RAINER AVE S RENTON, WA (425) NE SUNSET BLVD RENTON, WA (425) WAL-MART * 743 RAINIER AVE S RENTON, WA (425) SAMMAMISH BARTELL DRUGS * TH AVE NE SAMMAMISH, WA (425) ISSAQUAH PINE LAKE SAMMAMISH, WA (425) SEATAC 40 S 64TH ST SEATAC, WA 9888 (206) SEATTLE AFH PHARAMCY * 07 E UNION ST SEATTLE, WA 9822 (206) AHP 20 CHERRY ST STE 24 SEATTLE, WA 9804 (206) BALLARD PLAZA 80 NW MARKET ST STE 04 SEATTLE, WA 9807 (206) BARTELL DRUGS * 600 ST AVE N SEATTLE, WA 9809 (206) BARTELL DRUGS * 20 N 85TH ST SEATTLE, WA 9803 (206)

103 BARTELL DRUGS * TH AVE SW SEATTLE, WA 9806 (206) BARTELL DRUGS * 308 NE 25TH ST SEATTLE, WA 9825 (206) BARTELL DRUGS * ND AVE SW SEATTLE, WA 986 (206) BARTELL DRUGS * ND AVE SW SEATTLE, WA 986 (206) BARTELL DRUGS * 265 PACIFIC HWY S SEATTLE, WA 9898 (206) BARTELL DRUGS * 4344 UNIVERSITY WAY NE SEATTLE, WA 9805 (206) BARTELL DRUGS * ND AVE W SEATTLE, WA 9899 (206) BARTELL DRUGS * 404 3RD AVE SEATTLE, WA 980 (206) BARTELL DRUGS * 2700 NE UNIVERSITY VILLAGE ST SEATTLE, WA 9805 (206) BARTELL DRUGS * 407 BROADWAY AVE SEATTLE, WA 9822 (206) BARTELL DRUGS * ND AVE NW SEATTLE, WA 9807 (206) BARTELL DRUGS * 0 MADISON ST SEATTLE, WA 9804 (206) BARTELL DRUGS * 640 2TH AVE NE SEATTLE, WA 985 (206) BARTELL DRUGS * 820 N 45TH ST SEATTLE, WA 9803 (206) BARTELL DRUGS * 90 4TH AVE SEATTLE, WA 9834 (206) BARTELL DRUGS * 929 QUEEN ANNE AVE N SEATTLE, WA 9809 (206) BARTELL DRUGS * 2345 RAINIER AVE S SEATTLE, WA 9844 (206) BARTELL DRUGS * 00 MERCER ST SEATTLE, WA 9809 (206) BARTELL DRUGS * 500 NW MARKET ST STE 0 SEATTLE, WA 9807 (206) BOB JOHNSONS 407 NW 85TH ST SEATTLE, WA 987 (206) BUCK PAVILION MASON CLINIC 00 9TH AVE SEATTLE, WA 980 (206) CABRINI MEDICAL TOWER PHCY * 90 BOREN AVE SEATTLE, WA 9804 (206) CHESTERFIELD 720 7TH AVE STE 00 SEATTLE, WA 9804 (206) COLUMBIA 474 RAINIER AVE S SEATTLE, WA 988 (206) COMMUNITY * 00 BROADWAY STE 02 SEATTLE, WA 9822 (206)

104 COSTCO * 75 N 205TH ST SEATTLE, WA 9833 (206) COSTCO * 440 4TH AVE S SEATTLE, WA 9834 (206) COUNTRY DOCTOR COMMUNITY CLN * 500 9TH AVE E SEATTLE, WA 982 (206) DES MOINES DRUG TH ST S SEATTLE, WA 9898 (206) DONG NAI 620 S JACKSON ST SEATTLE, WA 9804 (206) DOWNTOWN PUBLIC HLTH CNTR PHCY 224 4TH AVE SEATTLE, WA 982 (206) FRED MEYER 3000 LAKE CITY WAY NE SEATTLE, WA 9825 (206) FRED MEYER 00 NW 85TH ST SEATTLE, WA 987 (206) FRED MEYER 8325 AURORA AVE N SEATTLE, WA 9833 (206) FRED MEYER 4300 ST AVE S SEATTLE, WA 9868 (206) FRED MEYER 95 NW 45TH ST SEATTLE, WA 9807 (206) HARBORVIEW MEDICAL CENTER * 325 9TH AVE SEATTLE, WA 9804 (206) HOLLY PARK 385 S OTHELLOS ST SEATTLE, WA 988 (206) INTERNATIONAL COMM HLTH SVCS * 720 8TH AVE S STE 00 SEATTLE, WA 9804 (206) KATTERMAN'S SAND POINT PHCY * 5400 SAND POINT WAY NE SEATTLE, WA 9805 (206) KELLEY ROSS LTC PHARMACY 2324 EASTLAKE AVE E SEATTLE, WA 9802 (206) KELLEY-ROSS 904 7TH AVE STE 03 SEATTLE, WA 9804 (206) KING PLAZA 70 MLK JR WAY S STE 0B SEATTLE, WA 988 (206) LAFFERRY'S 532 7TH AVE NW SEATTLE, WA 9807 (206) LINDEMAN PAVILION 20 TERRY AVE STE X2-PN SEATTLE, WA 980 (206) LOWRY'S PRESCRIPTIONS * 0330 MERIDIAN AVE N SEATTLE, WA 9833 (206) LUKE'S 6 MAYNARD AVE S SEATTLE, WA 9804 (206)

105 MAPLE LEAF 8830 ROOSEVELT WAY NE SEATTLE, WA 985 (206) MERIDIAN PHARMACY* 0 MERIDIAN AVE N SEATTLE, WA 9833 (206) NATURAL HEALTHCARE NORTHWEST * 509 OLIVE WAY STE 35 SEATTLE, WA 980 (206) NAVOS * 2600 SW HOLDEN ST SEATTLE, WA 9826 (206) NEIGHBORCARE HEALTH * TH AVE S SEATTLE, WA 988 (206) NEIGHBORCARE HEALTH * 930 POST ALY SEATTLE, WA 980 (206) NEIGHBORCARE HEALTH * 629 N 45TH ST SEATTLE, WA 9803 (206) NGUYENS PHARMACY AND GIFTS * 220 RAINIER AVE S SEATTLE, WA 9844 (206) NGUYENS PHARMACY AND GIFTS * 22 S MAIN ST STE 03 SEATTLE, WA 9844 (206) NORTH PUBLIC HEALTH CTR PHCY 050 MERIDIAN AVE N SEATTLE, WA 9833 (206) NORTHWEST KIDNEY CENTER PHCY * 700 BROADWAY SEATTLE, WA 9822 (206) NORTHWEST PRESCRIPTION * 536 N 5TH ST STE 00 SEATTLE, WA 9833 (206) NW NATUROPATHY AND ACUPUNCTURE * TH AVE NE STE 30 SEATTLE, WA 985 (206) PACIFIC DRUGS * 822 ST AVE SEATTLE, WA 9804 (206) PACMED CLINIC PHARMACY 046 5TH AVE NE SEATTLE, WA 9825 (206) PACMED CLINIC PHARMACY 200 2TH AVE S SEATTLE, WA 9844 (206) PACMED CLINIC PHARMACY 0 MADISON STE 306 SEATTLE, WA 9804 (206) PARK'S 40 NE RAVENNA BLVD STE A SEATTLE, WA 985 (206) PHARMACA INTEGRATIVE 4707 CALIFORNIA AVE SW SEATTLE, WA 986 (206) PHARMACA INTEGRATIVE PHCY * 430 EAST MADISON SEATTLE, WA 982 (206) PHARMACARE SPECIALTY PHCY * 00 MADISON ST SEATTLE, WA 9804 (206)

106 PLANNED PARENTHOOD OF GRT NW PHCY * 200 E MADISON ST SEATTLE, WA 9822 (206) QFC 47 BROADWAY E SEATTLE, WA 9802 (206) QFC 9999 HOLMAN RD NW SEATTLE, WA 987 (206) QFC 53 NE 45TH ST SEATTLE, WA 9855 (206) QFC 500 MERCER ST SEATTLE, WA 9809 (260) QFC 2746 NE 45TH ST SEATTLE, WA 9805 (206) QFC 00 ROOSEVELT WAY NE SEATTLE, WA 9825 (206) QFC 600 RICHMOND BEACH RD SEATTLE, WA 9877 (206) QFC ND AVE SW SEATTLE, WA 986 (206) QUE ARESTE ND * 605 2TH AVE STE 6 SEATTLE, WA 9822 (206) N AURORA AVE SEATTLE, WA 9833 (206) THIRD AVE SEATTLE, WA 982 (206) NW RICHMOND BEACH RD SEATTLE, WA 9877 (206) SW BARTON ST STE D SEATTLE, WA 9826 (206) CALIFORNIA AVE SW SEATTLE, WA 9836 (206) MADISON ST SEATTLE, WA 9804 (206) BOTHELL WAY NE STE 5 SEATTLE, WA 9855 (206) RAINIER AVE S SEATTLE, WA 988 (206) BROADWAY E SEATTLE, WA 9802 (206) TH AVE NE SEATTLE, WA 985 (206) RD AVE SEATTLE, WA 9804 (206) RXTRA CARE PHCY VIEW RIDGE * TH AVE NE SEATTLE, WA 985 (206) QUEEN ANNE AVE N SEATTLE, WA 9809 (206) ST AVE W SEATTLE, WA 989 (206)

107 7300 NE ROOSEVELT WAY SEATTLE, WA 985 (206) RAINIER AVE S SEATTLE, WA 988 (206) TH AVE NE SEATTLE, WA 985 (206) NE 45TH ST SEATTLE, WA 9805 (206) TH AVE SW SEATTLE, WA 9826 (206) AURORA AVE N SEATTLE, WA 9833 (206) E JOHN ST SEATTLE, WA 982 (206) NW MARKET ST SEATTLE, WA 9807 (206) SW 48TH ST SEATTLE, WA 9866 (206) RAINIER AVE S SEATTLE, WA 988 (206) TH AVE NE SEATTLE, WA 9855 (206) TH AVE NW SEATTLE, WA 987 (206) CALIFORNIA AVE SW SEATTLE, WA 986 (206) E MADISON ST SEATTLE, WA 982 (206) GREENWOOD AVE N SEATTLE, WA 9803 (206) SAM'S CLUB * 3550 AURORA AVE N SEATTLE, WA 9833 (206) SEA MAR CHC PHARMACY TH AVE S SEATTLE, WA 9808 (206) SEATTLE CANCER CARE ALLIANCE * 825 EASTLAKE AVE E SEATTLE, WA 9809 (206) SEATTLE CHILDREN'S 4800 SAND POINT WAY NE SEATTLE, WA 9805 (206) SEATTLEMEDS 305 MADISON ST SEATTLE, WA 9804 (206) SIMON WELLNESS * TH AVE NE STE 30 SEATTLE, WA 985 (206)

108 SWEDISH FIRST HILL 747 BROADWAY SEATTLE, WA 9822 (206) SWEDISH ORTHOPEDIC INST PHCY * 60 BROADWAY SEATTLE, WA 9822 (206) SWEDISH PHARMACY CHERRY HILL * 550 7TH AVE STE 80 SEATTLE, WA 9822 (206) TARGET 302 NE NORTHGATE WAY SEATTLE, WA 9825 (206) UNION CENTER 2324 EASTLAKE AVE E STE 405 SEATTLE, WA 9802 (206) UWMC AMBULATORY 959 NE PACIFIC ST SEATTLE, WA 9895 (206) VITAL THERAPEUTICS* 836 WESTLAKE AVE N STE 20 SEATTLE, WA 9809 (206) PIKE ST SEATTLE, WA 980 (206) LAKE CITY WAY NE SEATTLE, WA 9825 (206) TH AVE SW SEATTLE, WA 9806 (206) RAINIER AVE S SEATTLE, WA 988 (206) NE NORTHGATE WAY SEATTLE, WA 9825 (206) GREENWOOD AVE N SEATTLE, WA 9803 (206) TH AVE NW STE A SEATTLE, WA 987 (206) S JACKSON ST SEATTLE, WA 9844 (206) TH AVE SW SEATTLE, WA 9826 (206) TH AVE NW SEATTLE, WA 9807 (206) DENNY WAY SEATTLE, WA 9809 (206) STONE WAY N SEATTLE, WA 9803 (206) NE 50TH ST SEATTLE, WA 9805 (206) BROADWAY BLVD SEATTLE, WA 9822 (206) WHITE CENTER 960 6TH AVE SW SEATTLE, WA 9806 (206) SHORELINE BARTELL DRUGS * 8420 AURORA AVE N SHORELINE, WA 9833 (206)

109 20330 BALLINGER WAY NE SHORELINE, WA 9855 (206) SHORELINE NATURAL MEDICINE * 646 NW RICHMOND BEACH RD SHORELINE, WA 9877 (206) TOP FOOD AND DRUG* 20 N 75TH ST SHORELINE, WA 9833 (206) AURORA AVE N SHORELINE, WA 9833 (206) AURORA AVE N SHORELINE, WA 9833 (206) TH AVE NE SHORELINE, WA 9855 (206) SNOQUALMIE SNOQUALMIE VILLAGE PHARMACY* 7730 CENTER BLVD SE SNOQUALMIE, WA (425) THE FALLS PHCY UNITED DRUGS * 82 RAILROAD AVE SE SNOQUALMIE, WA (425) TUKWILA BARTELL DRUGS * 4277 PACIFIC HWY S TUKWILA, WA 9868 (206) COSTCO * 400 COSTCO DR TUKWILA, WA 9888 (206) PARAMOUNT 7200 S 80TH ST STE 04 TUKWILA, WA 9888 (425) TARGET 30 STRANDER BLVD TUKWILA, WA 9888 (206) S 44TH ST TUKWILA, WA 9868 (206) VASHON VASHON PHARMACY 767 VASHON HWY SW VASHON, WA (206) WOODINVILLE 4035 NE WOODINVILLE DUVALL WOODINVILLE, WA (425) WOODINVILLE DUVALL RD WOODINVILLE, WA (425) TARGET 3950 NE 78TH PL WOODINVILLE, WA (425) THE NATURAL PATH TO HEALING * 560 NE WOODINVILLE DUVALL WOODINVILLE, WA (425)

110 TOP FOOD AND DRUG* 764 GARDEN WAY NE WOODINVILLE, WA (425) TREE OF HEALTH INTEGRATIVE * 73 35TH AVE NE STE A250 WOODINVILLE, WA (425) AVONDALE RD NE WOODINVILLE, WA (425) WOODINVILLE MED CTR PHCY * TH AVE NE UNIT E0 WOODINVILLE, WA (425) KITSAP COUNTY BAINBRIDGE ISLAND 30 HIGH SCHOOL RD NE BAINBRIDGE ISLAND, WA 980 (206) HIGH SCHOOL RD NE BAINBRIDGE ISLAND, WA 980 (206) WINSLOW DRUG * 290 WINSLOW WAY E BAINBRIDGE ISLAND, WA 980 (206) BREMERTON ALBERTSON'S * 2900 WHEATON WAY BREMERTON, WA 9830 (360) APOTHECARY SHOPPE * 2500 CHERRY AVE STE 0 BREMERTON, WA 9830 (360) FRED MEYER 5050 STATE HIGHWAY 303 NE BREMERTON, WA 983 (360) PENINSULA COMMUNITY HEALTH SVS * 2508 WHEATON WAY BREMERTON, WA 9830 (360) PENINSULA COMMUNITY HLTH SRVS * 66 6TH ST BREMERTON, WA (360) WHEATON WAY BREMERTON, WA 9830 (360) CALLOW AVE BREMERTON, WA 9832 (360) NE MCWILLIAMS RD BREMERTON, WA 983 (360) KITSAP WAY BREMERTON, WA 9832 (360) STATE HWY 303 NE BREMERTON, WA 983 (360)

111 3333 WHEATON WAY BREMERTON, WA 9830 (360) WAL-MART * 6797 STATE HWY 303 NE BREMERTON, WA 983 (360) KINGSTON ALBERTSON'S * 896 NE STATE HIGHWAY 04 KINGSTON, WA (360) MILLER BAY RD NE KINGSTON, WA (360) PORT ORCHARD ALBERTSON'S * 390 SW SEDGEWICK RD PORT ORCHARD, WA (360) ALBERTSON'S * 434 OLNEY ST SE PORT ORCHARD, WA (360) FRED MEYER 900 SE SEDGWICK RD PORT ORCHARD, WA (360) PENINSULA COMMUNITY HLTH SVCS * 320 S KITSAP BLVD PORT ORCHARD, WA (360) BETHEL RD SE PORT ORCHARD, WA (360) BETHEL RD SE PORT ORCHARD, WA (360) SOUTH PARK 743 VILLAGE LN SE PORT ORCHARD, WA (360) BETHEL RD SE PORT ORCHARD, WA (360) WAL-MART * 3497 BETHEL RD SE PORT ORCHARD, WA (360) POULSBO KITSAP TH AVE NE POULSBO, WA (360) PENINSULA COMM HTLH SVCS PHCY * 997 7TH AVE NE POULSBO, WA (360) POULSBO COMPOUNDING 325 NE HOSTMARK ST POULSBO, WA (360) NE 7TH AVE POULSBO, WA (360) TH AVE NE POULSBO, WA (360) WAL-MART * 2200 OLHAVA WAY NW POULSBO, WA (360)

112 SILVERDALE ALBERTSON'S * 2222 NW BUCKLIN HILL RD SILVERDALE, WA (360) COSTCO * 0000 MICKELBERRY RD NW SILVERDALE, WA (360) NATURAL OPTIONS HEALTH CLINIC * 948 BAYSHORE DR NW SILVERDALE, WA (360) NW BUCKLIN HILL RD SILVERDALE, WA (360) TARGET 320 NW RANDALL WAY SILVERDALE, WA (360) SILVERDALE WAY NW SILVERDALE, WA (360) KITTITAS COUNTY CLE ELUM CAVALLINI'S 06 E ST ST CLE ELUM, WA (509) CLE ELUM DRUG * 29 E ST ST CLE ELUM, WA (509) ELLENSBURG BI-MART 608 E MOUNTAIN VIEW AVE ELLENSBURG, WA (509) ELLENSBURG DOWNTOWN HM PHCY * 44 N PEARL ST ELLENSBURG, WA (509) ELLENSBURG 52 E MOUNTAIN VIEW AVE ELLENSBURG, WA (509) S MAIN ST ELLENSBURG, WA (509) NORTH RUBY ST ELLENSBURG, WA (509) SUPER ONE 200 E MOUNTAIN VIEW AVE ELLENSBURG, WA (509) KLICKITAT COUNTY WHITE SALMON HI-SCHOOL 250 E JEWETT BLVD WHITE SALMON, WA (509) LEWIS CENTRALIA HALLS DRUG CENTER* 505 S TOWER AVE STE 2 CENTRALIA, WA 9853 (360) PROVIDENCE CENTRALIA HOSPITAL 94 S SCHEUBER RD CENTRALIA, WA 9853 (360)

113 200 HARRISON AVE CENTRALIA, WA 9853 (360) HARRISON AVE CENTRALIA, WA 9853 (360) CHEHALIS KMART 20 NW LOUISIANA AVE CHEHALIS, WA (360) S MARKET BLVD CHEHALIS, WA (360) S MARKET BLVD CHEHALIS, WA (360) NW LOUISIANA AVE CHEHALIS, WA (360) WAL-MART * 60 NW LOUISIANA AVE CHEHALIS, WA (360) MORTON COLTON 377 S 2ND ST MORTON, WA (360) WINLOCK CEDAR VILLAGE 206 E WALNUT ST WINLOCK, WA (360) LINCOLN COUNTY DAVENPORT DAVENPORT GOOD NEIGHBOR PHCY * 525 MORGAN ST DAVENPORT, WA 9922 (509) LINCOLN COUNTY HLTH MRT PHCY * 62RGAN ST DAVENPORT, WA 9922 (509) MASON COUNTY BELFAIR QFC 20 NE STATE ROUTE 300 BELFAIR, WA (360) NE STATE ROUTE 3 BELFAIR, WA (360) NE STATE ROUTE 3 BELFAIR, WA (360) SHELTON FRED MEYER 30 E WALLACE KNEELAND BLVD SHELTON, WA (360) MEDICINE SHOPPE 207 PROFESSIONAL WAY SHELTON, WA (360) NEIL'S 52 W FRANKLIN ST SHELTON, WA (360) FRANKLIN ST SHELTON, WA (360) WAL-MART * 00 E WALLACE KNEELAND BLVD SHELTON, WA (360)

114 OKANOGAN COUNTY BREWSTER BREWSTER HEALTH MART DRUG * 8 STATE HWY 97 NINTH BREWSTER, WA 9882 (509) FAMILY HEALTH CENTERS * 525 W JAY ST BREWSTER, WA 9882 (509) OKANOGAN DOUGLAS HOSPITAL PHCY * 507 HOSPITAL WAY BREWSTER, WA 9882 (509) OKANOGAN OKANOGAN VALLEY 236 2ND AVE N OKANOGAN, WA (509) OMAK OMAK 903 ENGH RD STE A OMAK, WA 9884 (509) OMACHE DR OMAK, WA 9884 (509) WAL-MART * 902 ENGH RD OMAK, WA 9884 (509) TONASKET ROY'S HEALTH MART 38 S WHITCOMB AVE TONASKET, WA (509) TWISP ULRICH VALLEY HEALTH MART PHCY 423 E METHOW VALLEY HWY TWISP, WA (509) PACIFIC COUNTY LONG BEACH LONG BEACH 0 BOLSTAD AVE E LONG BEACH, WA 9863 (360) OCEAN PARK OCEAN PARK 50 BAY AVE OCEAN PARK, WA (360) RAYMOND SAGENS 55 COMMERCIAL ST RAYMOND, WA (360) SOUTH BEND SOUTH BEND 0 WILLAPA AVE SOUTH BEND, WA (360) PEND OREILLE COUNTY NEWPORT 2 W WALNUT ST NEWPORT, WA 9956 (509) SEEBER'S HEALTH MART * 336 S WASHINGTON AVE NEWPORT, WA 9956 (509) PIERCE COUNTY AUBURN HAGGEN FOOD AND 406 LAKE TAPPS PKWY E AUBURN, WA (253)

115 502 LAKE TAPPS PKWY SE AUBURN, WA (253) BONNEY LAKE FRANCISCAN PHCY BONNEY LAKE * 9230 SKY ISLAND DR E BONNEY LAKE, WA 9839 (253) FRED MEYER 2090 STATE ROUTE 40 E BONNEY LAKE, WA 9839 (253) MULTICARE BONNEY LAKE TH AVE E STE 200 BONNEY LAKE, WA 9839 (253) STATE RTE 40 E BONNEY LAKE, WA 9839 (253) RXPRESS PHARMACY* 2509 SR 40 E STE 4 BONNEY LAKE, WA 9839 (253) TARGET ND AVE E BONNEY LAKE, WA 9839 (253) WAL-MART * 9205 SR 40 E BONNEY LAKE, WA 9839 (253) BUCKLEY CHUCK'S DRUGS * 787 MAIN ST BUCKLEY, WA 9832 (360) DUPONT DUPONT 545 WILMINGTON DR STE 60 DUPONT, WA (253) EDGEWOOD 729 MERIDIAN AVE E EDGEWOOD, WA 9837 (253) FIRCREST FIRCREST 07 REGENTS BLVD FIRECREST, WA (253) GIG HARBOR ALBERTSON'S * 330 5ST AVE NW GIG HARBOR, WA (253) BARTELL DRUGS * 5500 OLYMPIC DR NW GIG HARBOR, WA (253) COSTCO * 0990 HARBOR HILL DR GIG HARBOR, WA (253) COSTLESS SENIOR SERVICES * ND AVE NW STE B GIG HARBOR, WA (253) FRANCISCAN PHCY ST ANTHONY * 5 CANTERWOOD BLVD NW GIG HARBOR, WA (253) MT RAINIER CLINIC WHOLISTIC * 672 KIMBALL DR STE 00 GIG HARBOR, WA (253)

116 MULTICARE GIG HARBOR PHARMACY* 4545 POINT FOSDICK DR NW GIG HARBOR, WA (253) OLYMPIC PHCY AND HEALTH CARE * 4700 PT FOSDICK DR NW GIG HARBOR, WA (253) PURDY COST LESS PRESCRIPTIONS * ND AVE NW GIG HARBOR, WA (253) POINT FOSDICK DR NW GIG HARBOR, WA (253) POINT FOSDICK DR NW GIG HARBOR, WA (253) TARGET 400 5ST AVE NW GIG HARBOR, WA (253) BORGEN BLVD GIG HARBOR, WA (253) GRAHAM 2220 MERIDIAN AVE E GRAHAM, WA (253) TH ST E GRAHAM, WA (253) LAKEWOOD FRANCISCAN PHARMACY ST CLARE * 35 BRIDGEPORT WAY SW LAKEWOOD, WA (253) GOOD 874 S TACOMA WAY LAKEWOOD, WA (253) INTERNATIONAL 228 BRIDGEPORT SW LAKEWOOD, WA (253) LAKEWOOD 8720 S TACOMA WAY STE 03 LAKEWOOD, WA (253) TH ST SW STE 00 LAKEWOOD, WA (253) STEILACOOM BLVD SW LAKEWOOD, WA (253) WAL-MART * 700 BRIDGEPORT WAY W LAKEWOOD, WA (253) MILTON ALBERTSON'S * 2800 MILTON WAY STE 0 MILTON, WA (253) MERIDIAN E MILTON, WA (253)

117 900 MERIDIAN E MILTON, WA (253) ORTING COPE'S 34 WASHINGTON AVE S ORTING, WA (360) WHITESELL ST NW ORTING, WA (360) PUYALLUP ALBERTSON'S * 02 CANYON RD E PUYALLUP, WA (253) BEALL'S 0 W MEEKER PUYALLUP, WA 9837 (253) COSTCO * 20 39TH AVE SW PUYALLUP, WA (253) FRANCISCAN 524 CANYON RD E STE 0 PUYALLUP, WA (253) FRED MEYER 00 N MERIDIAN STE 2 PUYALLUP, WA 9837 (253) GOOD SAMARITAN BEHAVIORAL HLTH * 325 E PIONEER AVE PUYALLUP, WA (253) KIRK'S TH ST SE STE 2 PUYALLUP, WA (253) KIRK'S 22 SUNRISE BLVD E PUYALLUP, WA (253) MULTICARE GOOD SAMARITAN PHCY * 450 5TH ST SE STE 200 PUYALLUP, WA (253) PARTNER ONCOLOGY* 59 3RD ST SE STE 260 PUYALLUP, WA (253) TH ST E PUYALLUP, WA (253) E CANYON RD PUYALLUP, WA (253) E MAIN AVE PUYALLUP, WA (253) MERIDIAN ST E PUYALLUP, WA (253) MERIDAN ST E PUYALLUP, WA (253) CANYON RD E PUYALLUP, WA (253) TH ST E PUYALLUP, WA (253) S MERIDIAN PUYALLUP, WA 9837 (253) TARGET 330 S MERIDIAN PUYALLUP, WA (253)

118 TARGET TH ST E PUYALLUP, WA (253) TOP FOOD & DRUG * 20 37TH AVE SE PUYALLUP, WA (253) MERIDIAN E PUYALLUP, WA (253) MERIDIAN E PUYALLUP, WA (253) CANYON RD E PUYALLUP, WA (253) WAL-MART * 6502 MERIDIAN E PUYALLUP, WA (253) WAL-MART * 30 3ST AVE SE PUYALLUP, WA (253) SPANAWAY FRED MEYER MOUNTAIN HWY E SPANAWAY, WA (253) E MOUNTAIN HWY SPANAWAY, WA (253) WAL-MART * MOUNTAIN HWY E SPANAWAY, WA (253) SUMNER FRED MEYER 20 VALLEY AVE SUMNER, WA (253) NICHOLSON'S SUMNER 90 ALDER AVE SUMNER, WA (253) HIGHWAY 40 SUMNER, WA (253) TACOMA ALBERTSON'S * 04 MILITARY RD S TACOMA, WA (253) ALLENMORE OUTPATIENT 90 S UNION AVE TACOMA, WA (253) BARTELL DRUGS * 360 6TH AVE TACOMA, WA (253) CHUNG 922 SOUTH TACOMA WAY TACOMA, WA (253) COMM HEALTH CARE HILLTOP PHCY * 202 MARTIN LUTHER KING JR TACOMA, WA (253) COMMUNITY HEALTHCARE 225 PACIFIC AVE S TACOMA, WA (253) COMMUNITY HEALTHCARE 708 E 44TH ST TACOMA, WA (253) COST LESS PRESCRIPTIONS * 543 PACIFIC AVE TACOMA, WA (253) COST PHARMACY- FIRCREST * 09 REGENTS BLVD TACOMA, WA (253)

119 COSTCO * 229 S 37TH ST TACOMA, WA (253) FRANCISCAN PHARMACY ST JOSEPH * 708 YAKIMA AVE STE 20 TACOMA, WA (253) FRANCISCAN PHARMACY TACOMA* 608 S J ST TACOMA, WA (253) FRED MEYER 690 S 9TH ST TACOMA, WA (253) FRED MEYER 7250 PACIFIC AVE TACOMA, WA (253) FRED MEYER 4505 S 9TH ST TACOMA, WA (253) KMART 44 E 72ND ST TACOMA, WA (253) LINCOLN PHARMACY* 82 S 38TH ST TACOMA, WA 9848 (253) MAI LINH PHARMACY* 2 S TH ST TACOMA, WA (253) MARY BRIDGE RETAIL CLINIC PHCY * 3 S L ST TACOMA, WA (253) MEGA TH ST S STE A TACOMA, WA (253) MULTICARE CLINIC 52 MLK JR WAY TACOMA, WA (253) MULTICARE MEDICAL CENTER PHCY * 35 MLK JR WAY TACOMA, WA (253) MULTICARE WESTGATE 2209 N PEARL ST STE 00 TACOMA, WA (253) NATURAL HEALTH AND EDU SVCS * 20 N I ST STE C TACOMA, WA (253) PARKLAND MARKETPLACE 3322 PACIFIC AVE S TACOMA, WA (253) PUGET SOUND 2 6TH AVE STE 0 TACOMA, WA (253) RANKOS STADIUM 0 N TACOMA AVE TACOMA, WA (253) S MILDRED ST TACOMA, WA (253) N PEARL ST TACOMA, WA (253) PACIFIC AVE S TACOMA, WA (253) W BRIDGEPORT WAY TACOMA, WA (253) PACIFIC AVE TACOMA, WA (253)

120 RUMED 3602 CENTER ST # 4 TACOMA, WA (253) N PEARL ST TACOMA, WA (253) S M ST TACOMA, WA (253) TH ST S TACOMA, WA 9848 (253) ND ST E TACOMA, WA (253) N PROCTOR ST TACOMA, WA (253) S 56TH ST TACOMA, WA (253) TH AVE TACOMA, WA (253) GRAVELLY LAKE DR SW TACOMA, WA (253) TACOMA MEDICAL CENTER 206 S TH ST STE TACOMA, WA (253) TARGET 0509 GRAVELLY LAKE DR SW TACOMA, WA (253) TARGET 3320 S 23RD ST TACOMA, WA (253) TOP FOOD AND DRUG* 330 S 23RD ST TACOMA, WA (253) PACIFIC AVE S TACOMA, WA (253) PACIFIC AVE TACOMA, WA (253) PACIFIC AVE TACOMA, WA 9848 (253) BRIDGEPORT WAY SW TACOMA, WA (253) TH AVE TACOMA, WA (253) PACIFIC AVE S TACOMA, WA (253) PACIFIC AVE TACOMA, WA (253) N PEARL ST TACOMA, WA (253) TH AVE TACOMA, WA (253) WAL-MART * 965 S UNION AVE TACOMA, WA (253) UNIVERSITY PLACE BARTELL DRUGS * 2700 BRIDGEPORT WAY STE D UNIVERSITY PLACE, WA (253)

121 FRANCISCAN HOSPICE LTC PHCY * 290 BRIDGEPORT WAY W UNIVERSITY PLACE, WA (253) FRED MEYER 6305 BRIDGEPORT WAY W UNIVERSITY PLACE, WA (253) CIRQUE DR W UNIVERSITY PLACE, WA (253) BRIDGEPORT WAY W UNIVERSITY PLACE, WA (253) SAN JUAN COUNTY EASTSOUND RAYS 5 TEMPLIN CTR EASTSOUND, WA (360) FRIDAY HARBOR FRIDAY HARBOR DRUG * 20 SPRING ST W FRIDAY HARBOR, WA (360) LOPEZ ISLAND LOPEZ ISLAND PHARMACY 352 LOPEZ RD LOPEZ ISLAND, WA 9826 (360) SKAGIT COUNTY ANACORTES FAMILY 23 24TH ST STE 400 ANACORTES, WA 9822 (360) COMMERCIAL AVE ANACORTES, WA 9822 (360) TH ST ANACORTES, WA 9822 (360) TH ST ANACORTES, WA 9822 (360) BURLINGTON COSTCO * 725 S BURLINGTON BLVD BURLINGTON, WA (360) FRED MEYER 920 S BURLINGTON BLVD BURLINGTON, WA (360) HAGGEN FOOD AND DRUG * 757 HAGGEN DR BURLINGTON, WA (360) S BURLINGTON BLVD BURLINGTON, WA (360) CONCRETE EAST VALLEY 7438 S D AVE STE C CONCRETE, WA (360)

122 LA CONNER LA CONNER DRUG * 708 E MORRIS ST LA CONNER, WA (360) MOUNT VERNON HAGGEN FOOD AND 260 E DIVISION ST MOUNT VERNON, WA (360) HILLTOP 223 E DIVISION ST MOUNT VERNON, WA (360) E COLLEGE WAY MOUNT VERNON, WA (360) SEA MAR CHC 400 N LAVENTURE MOUNT VERNON, WA (360) SKAGIT REGIONAL CLINICS PHCY * 40 E KINCAID ST MOUNT VERNON, WA (360) SKAGIT VALLEY HOSP 45 E KINCAID ST MOUNT VERNON, WA (360) SKAGIT VALLEY HOSPITAL OP PHCY * 45 E KINCAID ST MOUNT VERNON, WA (360) SRC RIVERBEND 2320 FREEWAY DR MOUNT VERNON, WA (360) WAL-MART * 230 FREEWAY DR MOUNT VERNON, WA (360) SEDRO WOOLLEY 85ORE ST SEDRO WOOLLEY, WA (360) SKAGIT REGIONAL CLINICS PHCY * 990 HOSPITAL DR STE 20 SEDRO WOOLLEY, WA (360) HARRISON ST SEDRO WOOLLEY, WA (360) HOAGLAND PHARMACY SOUTH * 640 SR HWY 20 SERDO WOOLLEY, WA (360) SKAMANIA COUNTY STEVENSON WIND RIVER 280 SW 2ND ST STEVENSON, WA (509) SNOHOMISH COUNTY ARLINGTON ARLINGTON CHC 326 S STILLAGUAMISH AVE ARLINGTON, WA (360) ARLINGTON 540 N WEST AVE ARLINGTON, WA (360)

123 HAGGEN FOOD & TH AVE NE ARLINGTON, WA (360) SMOKEY POINT BLVD ARLINGTON, WA (360) ND ST NE ARLINGTON, WA (360) SMOKEY POINT ND ST NE ARLINGTON, WA (360) WAL-MART * ND ST NE ARLINGTON, WA (360) BOTHELL BARTELL DRUGS * BOTHELL HWY BOTHELL, WA 9802 (425) BARTELL DRUGS * 800 BOTHELL EVERETT HWY BOTHELL, WA 9802 (425) FRED MEYER 2045 BOTHELL EVERETT HWY BOTHELL, WA 9802 (425) PACIFIC MEDICAL CENTER PHCY TH ST SE STE 300 BOTHELL, WA 9802 (425) SE BOTHELL WAY BOTHELL, WA 9802 (425) BOTHELL EVERETT HWY BOTHELL, WA 9802 (425) BOTHELL EVERETT HWY BOTHELL, WA 9802 (425) BOTHELL EVERETT HWY BOTHELL, WA 9802 (425) DARRINGTON DARRINGTON 200 SEEMANN ST DARRINGTON, WA 9824 (360) EDMONDS BARTELL DRUGS * TH AVE W EDMONDS, WA (425) EDMONDS TH AVE W STE 04A EDMONDS, WA (425) EDMONDS TH ST SW STE 00 EDMONDS, WA (425) EDMONDS WELLNESS CLINIC * TH ST SW STE E EDMONDS, WA (425) FAMILY TH ST SW STE 00 EDMONDS, WA (425)

124 HIGHLAND 2268 HIGHWAY 99 STE 09 EDMONDS, WA (425) PAVILION PHARMACY* TH ST SW STE 00 EDMONDS, WA (425) QFC TH AVE W EDMONDS, WA (425) HIGHWAY 99 EDMONDS, WA (425) HIGHWAY 99 EDMONDS, WA (425) THE COMPOUNDING APOTHECARY * 300 ADMIRAL WAY STE 07 EDMONDS, WA (425) TOP FOOD AND DRUG* 2900 HIGHWAY 99 EDMONDS, WA (425) EDMONDS WAY EDMONDS, WA (425) EVERETT 2TH STREET CHC 09 2TH ST SW EVERETT, WA (425) ALBERTSON'S * TH ST SW EVERETT, WA (425) ALBERTSON'S * 6727 EVERGREEN WAY EVERETT, WA (425) BARTELL DRUGS * 020 9TH AVE SE EVERETT, WA (425) BARTELL DRUGS * 825 BROADWAY EVERETT, WA 9820 (425) BARTELL DRUGS * ND ST SE STE A EVERETT, WA (425) BARTELL DRUGS * 3909 HOYT AVE EVERETT, WA 9820 (425) BROADWAY CHC 40 BROADWAY EVERETT, WA 9820 (425) COSTCO * TH AVE SE EVERETT, WA (425) EVERETT FOOT CLINIC * 340 RUCKER AVE EVERETT, WA 9820 (425) FRED MEYER 2906 BOTHWELL EVERETT, WA (425) HAGGEN FOOD AND 895 MARKET PLACE DR EVERETT, WA (425) JODI BERGS INTGRTVE FMLY HLTH* 3903 COLBY AVE EVERETT, WA 9820 (425) MCQUINN NATUROPATHIC * 2808 HOYT AVE STE 20 EVERETT, WA 9820 (425)

125 MEDICAL CENTER 32 COLBY C WING ST FL EVERETT, WA 9820 (425) MOLINA HEALTHCARE * 5 SW EVERETT MALL WAY EVERETT, WA (952) PHYSICAL REHABILITATION * 99 28TH ST SW EVERETT, WA (425) PROVIDENCE MILL CREEK PHCY * 2800 BOTHELL EVERETT HWY EVERETT, WA (425) QFC 499 EVERGREEN WAY EVERETT, WA (425) QFC 265 BROADWAY EVERETT, WA 9820 (425) A EVERGREEN WAY EVERETT, WA (425) EVERGREEN WAY EVERETT, WA (425) TH PL SE EVERETT, WA (425) EVERGREEN WAY EVERETT, WA (425) RUCKER AVE EVERETT, WA 9820 (425) TH AVE SE EVERETT, WA (425) BROADWAY AVE EVERETT, WA 9820 (425) SEVAN 620 SE EVERETT MALL WAY EVERETT, WA (425) SHIRAZ SPECIALTY 205 E CASINO RD STE B6 EVERETT, WA (425) SOUND HOLISTIC HEALTH * 2804 GRAND AVE STE 300 EVERETT, WA 9820 (425) TARGET 405 SE EVERETT MALL WAY EVERETT, WA (425) EVERGREEN WAY EVERETT, WA (425) BOTHELL EVERETT HWY EVERETT, WA (425) TH AVE W EVERETT, WA (425) BROADWAY EVERETT, WA 9820 (425) WAL-MART * 400 HIGHWAY 99 EVERETT, WA (425)

126 GRANITE FALLS PHARM-A-SAVE 207 E STANLEY ST GRANITE FALLS, WA (360) W STANLEY ST GRANITE FALLS, WA (360) LAKE STEVENS BARTELL DRUGS * 62 HIGHWAY 9 LAKE STEVENS, WA (425) ST AVE NE LAKE STEVENS, WA (425) TARGET 960 MARKET PL LAKE STEVENS, WA (425) ST AVE NE LAKE STEVENS, WA (425) LYNNWOOD ALBERTSON'S * 9500 HIGHWAY 99 LYNNWOOD, WA (425) ALBERTSON'S * 28 BEVERLY PARK RD LYNNWOOD, WA (425) BARTELL DRUGS * TH ST SW STE B LYNNWOOD, WA (425) BETHEL 744 HIGHWAY 99 STE 00 LYNNWOOD, WA (425) FRED MEYER TH ST SW LYNNWOOD, WA (425) FRED MEYER TH ST SW LYNNWOOD, WA (425) LYNNWOOD CHC 4 94TH ST SW LYNNWOOD, WA (425) PHARMACY CARE * TH ST SW STE A LYNNWOOD, WA (425) TH ST SW STE A LYNNWOOD, WA (425) B 33RD AVE W LYNNWOOD, WA (425) HIGHWAY 99 LYNNWOOD, WA (425) HIGHWAY 99 LYNNWOOD, WA (425)

127 TARGET 8305 ALDERWOOD MALL PKWY LYNNWOOD, WA (425) HIGHWAY 99 LYNNWOOD, WA (425) LARCH WAY LYNNWOOD, WA (425) HWY 99 LYNNWOOD, WA (425) WAL-MART * TH ST SW LYNNWOOD, WA (425) WAL-MART * 7222 HIGHWAY 99 LYNNWOOD, WA (425) MARYSVILLE ALBERTSON'S * 30 MARYSVILLE MALL # 60 MARYSVILLE, WA (360) BARTELL DRUGS * TH ST NE MARYSVILLE, WA (360) COSTCO * 666 TWIN LAKES AVE MARYSVILLE, WA 9827 (360) FRED MEYER 9925 STATE AVE MARYSVILLE, WA (360) HAGGEN FOOD & 37 88TH ST NE MARYSVILLE, WA (360) HILTON 220 STATE AVE MARYSVILLE, WA (360) MARYSVILLE MALL MARYSVILLE, WA (360) STATE AVE MARYSVILLE, WA (360) TARGET 688 TWIN LAKES AVE MARYSVILLE, WA 9827 (360) STATE AVE MARYSVILLE, WA (360) WAL-MART * TH ST NE MARYSVILLE, WA (360) MILL CREEK ALBERTSON'S * ND ST SE MILL CREEK, WA 9802 (425) MILL CREEK RD ST SE STE 04 MILL CREEK, WA 9802 (425) PURITY INTEGRATIVE HEALTH CTR * 58 MAIN ST STE 500 MILL CREEK, WA 9802 (425)

128 QFC TH ST SE MILL CREEK, WA 9802 (425) BOTHELL EVERETT HWY MILL CREEK, WA 9802 (425) ND ST SE MILL CREEK, WA 9802 (425) BOTHELL EVERETT HWY MILL CREEK, WA 9802 (425) FRED MEYER 8805 STATE ROUTE 2 MONROE, WA (360) PHARM A SAVE MONROE * TH ST SE MONROE, WA (360) PROVIDENCE PHARMACY MONROE* 9200 N KELSEY ST MONROE, WA (360) STATE ROUTE 2 MONROE, WA (360) HIGHWAY 2 MONROE, WA (360) MOUNTLAKE TERRACE ALBERTSON'S * TH ST SW MOUNTLAKE TERRACE, WA (425) BARTELL DRUGS * TH AVE W MOUNTLAKE TERRACE, WA (425) MUKILTEO 700 MUKILTEO SPEEDWAY MUKILTEO, WA (425) MUKILTEO SPEEDWAY MUKILTEO, WA (425) SNOHOMISH ALBERTSON'S * 7520 STATE ROUTE 9 SE SNOHOMISH, WA (360) BARTELL DRUGS * 5 3TH ST SNOHOMISH, WA (360) FRED MEYER 280 BICKFORD AVE SNOHOMISH, WA (360) KUSLER'S 700 AVENUE D SNOHOMISH, WA (360) PINE ST SNOHOMISH, WA (360) TOP FOOD AND DRUG* 30 AVENUE D SNOHOMISH, WA (360)

129 STANWOOD BARTELL DRUGS * TH ST NW STANWOOD, WA (360) HAGGEN FOOD & ND AVE NW STANWOOD, WA (360) TH DR NW STANWOOD, WA (360) SULTAN SULTAN PHARMACY AND NAT CARE * 505 W STEVENS AVE SULTAN, WA (360) TULALIP TH ST NE TULALIP, WA 9827 (360) WAL-MART * 8924 QUILCEDA BLVD TULALIP, WA 9827 (360) WOODINVILLE COSTCO * SNO WOOD RD WOODINVILLE, WA (425) SPOKANE COUNTY AIRWAY HEIGHTS YOKES 2825 W SUNSET HWY AIRWAY HEIGHTS, WA 9900 (509) CHENEY BI-MART 222 ST ST CHENEY, WA (509) CHENEY OWL HEALTH MART PHCY * 20 F ST CHENEY, WA (509) ST ST CHENEY, WA (509) DEER PARK BI-MART 42 S MAIN AVE DEER PARK, WA (509) CHAS 40 S MAIN ST DEER PARK, WA (509) MEDICINE SHOPPE E H ST STE A DEER PARK, WA (509) YOKES 80 S MAIN ST DEER PARK, WA (509) FAIRFIELD FAIRFIELD OWL 208 MAIN ST FAIRFIELD, WA 9902 (509) LIBERTY LAKE ALBERTSON'S * 304 N LIBERTY LAKE RD LIBERTY LAKE, WA 9909 (509) MEDICINE MAN LIBERTY LAKE * 2380 E APPLEWAY AVE LIBERTY LAKE, WA 9909 (509)

130 233 N LIBERTY LAKE RD LIBERTY LAKE, WA 9909 (509) WELL LIFE LIBERTY LAKE * 2380 E APPLEWAY AVE LIBERTY LAKE, WA 9909 (509) MEAD YOKES 4202 N MARKET ST MEAD, WA 9902 (509) MEDICAL LAKE MEDICAL LAKE OWL 23 E LAKE ST MEDICAL LAKE, WA (509) MILLWOOD 2702 N ARGONNE RD MILLWOOD, WA 9922 (509) SPOKANE ST AVENUE 6 E ST AVE SPOKANE, WA (509) ALBERTSON'S * 6520 N NEVADA ST SPOKANE, WA (509) ALBERTSON'S * 900 N INDIAN TRAIL RD SPOKANE, WA (509) ALBERTSON'S * 300 E 57TH AVE SPOKANE, WA (509) ALBERTSON'S * 232 N DIVISION ST SPOKANE, WA 9928 (509) ALBERTSON'S * 50 W 37TH AVE SPOKANE, WA (509) BATES PHARMACEUTICAL SVCS * 3704 N NEVADA STE B SPOKANE, WA (509) BATES 3704 N NEVADA ST SPOKANE, WA (509) CHAS * 399 N MAPLE ST SPOKANE, WA (509) CHAS DENNY MURPHY 00 W 2ND AVE SPOKANE, WA 9920 (509) CHAS 592 N MARKET ST SPOKANE, WA (509) CHAS-NHOS * 803 W MAXWELL AVE SPOKANE, WA 9920 (509) COSTCO * 769 N DIVISION ST SPOKANE, WA (509) DEACONESS OUTPATIENT 800 W 5TH AVE SPOKANE, WA (509) EVERGREEN NATUROPATHIC * 35 W 9TH AVE STE 05 SPOKANE, WA (509) FIFTH AND BROWNE 04 W 5TH AVE STE 80E SPOKANE, WA (509)

131 FRED MEYER 400 SO THOR ST SPOKANE, WA (509) FRED MEYER 220 N DIVISION ST SPOKANE, WA (509) HART AND DILATUSH 60 W RIVERSIDE STE 40 SPOKANE, WA 9920 (509) KMART 40 E SPRAGUE AVE SPOKANE, WA (509) LIDGERWOOD OWL HM 590 N LIDGERWOOD ST SPOKANE, WA (509) MEDICAL ONCOLOGY ASSOCIATES PS * 600 N MAYFAIR ST SPOKANE, WA (509) MEDICINE SHOPPE 327 W NORTHWEST BLVD SPOKANE, WA (509) NORTHWEST HEALTH SYSTEMS * 288 N SULLIVAN RD BLDG 2E SPOKANE, WA 9926 (509) PAYLESS DRUG LTC PHARMACY 224 E WESTVIEW CT SPOKANE, WA 9928 (800) PROVIDENCO SACRED 0 W 8TH AVE SPOKANE, WA (509) N ARGONNE RD SPOKANE, WA 9922 (509) N DIVISION ST SPOKANE, WA 9928 (509) N DIVISION ST SPOKANE, WA (509) A WEST WELLESLEY AVE SPOKANE, WA (509) E 29TH AVE SPOKANE, WA (509) REGAL ST S SPOKANE, WA (509) E 29TH AVE SPOKANE, WA (509) N DIVISION ST SPOKANE, WA 9928 (509) N INDIAN TRAIL RD SPOKANE, WA (509) RIVERPOINT 528 E SPOKANE FALLS BLVD SPOKANE, WA (509) RIVERSTONE FAMILY HEALTH PHCY * 400 N COOK ST SPOKANE, WA (866) ROSAUERS 907 W 4TH SPOKANE, WA (509) ROSAUERS 724 W FRANCIS SPOKANE, WA (509)

132 ROSAUERS 260 E 29TH AVE SPOKANE, WA (509) ROSAUERS 068 E SPRAGUE AVE SPOKANE, WA (509) ROSAUERS 808 W 3RD AVE SPOKANE, WA (509) ROSAUERS 944 N DIVISION SPOKANE, WA 9928 (509) TH AVE E SPOKANE, WA (509) N MARKET ST SPOKANE, WA (509) W FRANCIS AVE SPOKANE, WA (509) W 66 NORTHWEST BLVD SPOKANE, WA (509) N ARGONNE RD SPOKANE, WA 9922 (509) N NEWPORT HWY SPOKANE, WA 9928 (509) E 933 MISSION AVE SPOKANE, WA (509) SHOPKO PHARMACY* (509) E 344 SPRAGUE AVE SPOKANE, WA 9926 (509) SHOPKO PHARMACY* 455 S REGAL ST SPOKANE, WA (509) SIXTH AVE MEDICAL 508 W 6TH AVE SPOKANE, WA (509) SPOKANE FALLS FAMILY CLIN PHCY * 20 W MISSION AVE SPOKANE, WA 9920 (866) TARGET 9770 N NEWPORT HWY SPOKANE, WA 9928 (509) W 5TH AVE STE 270 SPOKANE, WA (509) HIGHWAY 395 SHOPKO PHARMACY* SPOKANE, WA 9928 N 9520 NEWPORT (509) HWY SPOKANE, WA 9928 (509) S GRAND BLVD SPOKANE, WA E EMPIRE AVE SPOKANE, WA (509) E 5TH AVE STE 02 SPOKANE, WA (509)

133 7905 N DIVISION ST SPOKANE, WA (509) E WELLESLEY AVE SPOKANE, WA (509) W NORTHWEST BLVD SPOKANE, WA (509) WAL-MART * 922 N COLTON ST SPOKANE, WA 9928 (509) WAL-MART * 230 WEST WELLESLEY AVE SPOKANE, WA (509) WELL LIFE LATAH 4235 S CHENEY SPOKANE RD SPOKANE, WA (509) YOKES 20 E NORTH FOOTHILLS DR SPOKANE, WA (509) YOKES 332 W INDIAN TRAIL RD SPOKANE, WA (509) SPOKANE VALLEY ALBERTSON'S * 885 E TRENT AVE SPOKANE VALLEY, WA 9922 (509) ALBERTSON'S * 3606 E 32ND AVE SPOKANE VALLEY, WA 9926 (509) CHAS 924 S PINES RD SPOKANE VALLEY, WA (509) FRED MEYER 5609 E SPRAGUE AVE SPOKANE VALLEY, WA (509) MEDICINE SHOPPE 244 E SPRAGUE AVE SPOKANE VALLEY, WA 9926 (509) E SPRAGUE AVE SPOKANE VALLEY, WA (509) RITE AID PHARMACY* 6528 DESMET CT SPOKANE VALLEY, WA 9925 (509) E SPRAGUE AVE SPOKANE VALLEY, WA 9926 (509) TRADING COMPANY 304 E SPRAGUE AVE SPOKANE VALLEY, WA 9926 (509) VALLEY MISSION HOMECARE PHCY * 2509 E MISSION AVE STE 03 SPOKANE VALLEY, WA 9926 (509) E SPRAGUE AVE SPOKANE VALLEY, WA 9926 (509) WAL-MART * 5025 E SPRAGUE AVE SPOKANE VALLEY, WA 9922 (509)

134 YOKES 9329 E MONTGOMERY AVE SPOKANE VALLEY, WA (509) VERADALE 550 E SPRAGUE AVE VERADALE, WA (509) STEVENS COUNTY CHEWELAH AKERS UNITED DRUG* 406 PARK ST N CHEWELAH, WA 9909 (509) VALLEY HEALTH MART DRUG * 02 E MAIN AVE CHEWELAH, WA 9909 (509) COLVILLE PROVIDENCE HEALTH SERVICES WA * 200 E COLUMBIA AVE COLVILLE, WA 994 (509) N MAIN ST COLVILLE, WA 994 (509) SUPER ONE 250 NORTH HIGHWAY COLVILLE, WA 994 (509) WAL-MART * 80 N HIGHWAY ST COLVILLE, WA 994 (509) KETTLE FALLS KETTLE FALLS HEALTH MART PHCY 280 E 3RD AVE KETTLE FALLS, WA 994 (509) NINE MILE FALLS LAKE SPOKANE 599 HIGHWAY 29 STE 5 NINE MILE FALLS, WA (509) THURSTON COUNTY LACEY COSTCO * 470 MARVIN RD NE LACEY, WA 9856 (360) * FRED MEYER 700 SLEATER-KINNEY RD SE LACEY, WA (360) HAWKS PRAIRIE HEALTH MART PHCY * 2539 MARVIN RD NE LACEY, WA 9856 (360) METMEDS 5707 LACEY BLVD SE LACEY, WA (360) QFC 4775 WHITMAN LN SE LACEY, WA (360) SLEATER KINNEY RD SE LACEY, WA (360) WHITMAN LN SE LACEY, WA 9853 (360) MARVIN RD NE LACEY, WA 9856 (360) PACIFIC AVE SE LACEY, WA (360)

135 SHOPKO PHARMACY* 5500 MARTIN WAY LACEY, WA (425) TARGET 665 SLEATER KINNEY RD SE LACEY, WA (360) LACEY BLVD SE LACEY, WA (360) MARTIN WAY E LACEY, WA 9856 (360) WAL-MART * 40 GALAXY DR NE LACEY, WA (360) OLYMPIA ALBERTSON'S * 3520 PACIFIC AVE SE OLYMPIA, WA 9850 (360) MEDICAL CENTER 3525 ENSIGN RD NE OLYMPIA, WA (360) PROVIDENCE MOTHER JOSEPH CTR * 3333 ENSIGN RD NE OLYMPIA, WA (360) RALPH'S THRIFTWAY 908 4TH AVE E OLYMPIA, WA (360) MARTIN WAY E OLYMPIA, WA 9856 (360) COOPER POINT RD NW OLYMPIA, WA (360) MARTIN WAY E OLYMPIA, WA 9856 (360) HARRISON AVE NW OLYMPIA, WA (360) CLEVELAND AVE OLYMPIA, WA 9850 (360) SEA MAR COMMUNITY HEALTH CTRS * 3030 LIMITED LN NW OLYMPIA, WA (360) TOP FOOD AND DRUG* 33 COOPER POINT RD SW OLYMPIA, WA (360) VISTA ONCOLOGY * 420 MCPHEE RD SW OLYMPIA, WA (360) VISTA ONCOLOGY * 4 LILLY RD NE OLYMPIA, WA (360) COOPER POINT RD SW OLYMPIA, WA (360) YAUGER PARK 400 YAUGER WAY SW STE B OLYMPIA, WA (360) TENINO HEDDEN'S 96 W SUSSEX AVE TENINO, WA (360) TUMWATER ALBERTSON'S * 705 TROSPER RD SW TUMWATER, WA 9852 (360)

136 COSTCO * 5500 LITTLEROCK RD SW TUMWATER, WA 9852 (360) FRED MEYER 555 TROSPER RD SW TUMWATER, WA 9850 (360) MARTIN'S SOUTHGATE DRUG * 520 CAPITOL BLVD S TUMWATER, WA 9850 (360) TROSPER RD SW TUMWATER, WA 9852 (360) WAL-MART * 5600 LITTLEROCK RD SW TUMWATER, WA 9852 (360) YELM 909 E YELM AVE YELM, WA (360) YELM AVE E YELM, WA (360) TIM'S 06 ST ST S YELM, WA (360) WAL-MART * 700 STATE ROUTE 507 SE YELM, WA (360) WAHKIAKUM COUNTY CATHLAMET CATHLAMET 74 MAIN ST CATHLAMET, WA 9862 (360) WALLA WALLA COUNTY WALLA WALLA ADVENTIST HEALTH COMMUNITY * S 2ND AVE WALLA WALLA, WA (509) ALBERTSON'S * 450 N WILBUR AVE WALLA WALLA, WA (509) BI-MART 649 PLAZA WAY WALLA WALLA, WA (509) FAMILY MED CTR 20 W ROSE ST WALLA WALLA, WA (866) PROVIDENCE ST MARY 40 W POPLAR ST WALLA WALLA, WA (509) E ISAACS AVE WALLA WALLA, WA (509) PLAZA WAY WALLA WALLA, WA (509) E ROSE ST WALLA WALLA, WA (509) SHOPKO PHARMACY* 65 W ROSE ST WALLA WALLA, WA (509) TALLMANS 4 W MAIN ST WALLA WALLA, WA (509)

137 633 W TIETAN ST WALLA WALLA, WA (509) WHATCOM COUNTY BELLINGHAM COSTCO * 4299 GUIDE MERIDIAN ST BELLINGHAM, WA (360) CUSTOM PRESCRIPTION SHOPPE * 33 E MAPLE ST STE 0 BELLINGHAM, WA (360) FAIRHAVEN 5 HARRIS AVE BELLINGHAM, WA (360) FRED MEYER 225 W BAKERVIEW RD BELLINGHAM, WA (360) FRED MEYER 800 LAKEWAY DR BELLINGHAM, WA (360) HAGGEN FOOD AND 284 MERIDIAN ST BELLINGHAM, WA (360) HAGGEN FOOD AND 2900 WOBURN ST BELLINGHAM, WA (360) HAGGEN PHARMACY* 4545 CORDATA PKWY BELLINGHAM, WA (360) HOAGLAND PHARMACY LTC 44 MEADOR AVE STE H02 BELLINGHAM, WA (360) HOAGLAND'S PHARMACY* 2330 YEW ST BELLINGHAM, WA (360) INTERFAITH 28 UNITY ST BELLINGHAM, WA (360) NORTHWEST AVE BELLINGHAM, WA (360) E SUNSET DR STE 0 BELLINGHAM, WA (360) TH ST BELLINGHAM, WA (360) CORNWALL AVE BELLINGHAM, WA (360) TELEGRAPH RD BELLINGHAM, WA (360) E SUNSET DR STE 55 BELLINGHAM, WA (360)

138 TARGET 30 BELLIS FAIR PKWY BELLINGHAM, WA (360) GUIDE MERIDIAN BELLINGHAM, WA (360) E SUNSET DR BELLINGHAM, WA (360) WAL-MART * 4420 MERIDIAN ST BELLINGHAM, WA (360) BLAINE THRIFTY PAYLESS INC * 95 BOBLETT ST BLAINE, WA (360) EVERSON VALLEY DRUG * 208 E MAIN ST EVERSON, WA (360) TH AVE FERNDALE, WA (360) MAIN ST FERNDALE, WA (360) LYNDEN FAIRWAY DRUG * 758 FRONT ST STE 06 LYNDEN, WA (360) GUIDE MERIDIAN RD LYNDEN, WA (360) GUIDE MERIDAN RD LYNDEN, WA (360) SUMAS SUMAS DRUG * 35 CHERRY ST SUMAS, WA (360) WHITMAN COUNTY COLFAX TICK KLOCK DRUGS * 09 S MAIN ST COLFAX, WA 99 (509) GARFIELD GARFIELD PHARMACY 207 N 3RD STE 2 GARFIELD, WA 9930 (509) PULLMAN 630 GRAND AVE S PULLMAN, WA 9963 (509) SE BISHOP BLVD PULLMAN, WA 9963 (509) SHOPKO PHARMACY* S 450 GRAND AVE PULLMAN, WA 9963 (509) SID'S 825 SE BISHOP BLVD STE 30 PULLMAN, WA 9963 (509) SIDS PROFESSIONAL 825 S E BISHOP STE 30 B PULLMAN, WA 9963 (509) WAL-MART * 695 SE BISHOP BLVD PULLMAN, WA 9963 (509)

139 WSU HEALTH AND WELLNESS SVC * 25 SE WASHINGTON ST PULLMAN, WA 9963 (509) SAINT JOHN ST JOHN PHARMACY* 8 E FRONT ST SAINT JOHN, WA 997 (509) TEKOA TEKOA 24 N CROSBY TEKOA, WA (509) YAKIMA COUNTY GRANDVIEW YAKIMA VALLY FARM WORKERS * 000 WALLACE WAY GRANDVIEW, WA (866) SELAH HOWARD'S DRUG * 9 E 3RD AVE SELAH, WA (509) SELAH SAVE ON FOODS 800 N PARK CTR SELAH, WA (360) SUNNYSIDE BI-MART 0 W SOUTH HILL RD SUNNYSIDE, WA (509) YAKIMA VALLEY HWY STE C SUNNYSIDE, WA (509) N 6TH ST SUNNYSIDE, WA (509) WAL-MART * 2675 E LINCOLN AVE SUNNYSIDE, WA (509) YAKIMA NEIGHBORHOOD HEALTH * 67 SCOON RD SUNNYSIDE, WA (509) TOPPENISH GIBBONS PHARMACY* 7 S TOPPENISH AVE TOPPENISH, WA (509) W FIRST ST TOPPENISH, WA (509) YAKIMA VLY FARM WRKRS CLINIC * 58 W ST AVE TOPPENISH, WA (509) UNION GAP COSTCO * 230 LONGFIBRE RD UNION GAP, WA (509) MAIN ST UNION GAP, WA (509) SHOPKO PHARMACY* 2530 RUDKIN RD UNION GAP, WA (509) WAPATO HORIZON PHARMACY* 633 W ST ST WAPATO, WA 9895 (509) YAKIMA ALBERTSON'S * 60 W LINCOLN AVE YAKIMA, WA (509)

140 ALBERTSON'S * 40 S 40TH ST YAKIMA, WA (509) BI-MART 207 N 40TH AVE YAKIMA, WA (509) BI-MART 309 S 5TH AVE YAKIMA, WA (509) CENTRAL WA FAMILY MEDICINE * 806 W LINCOLN AVE YAKIMA, WA (509) FRED MEYER 206 N 40TH AVE YAKIMA, WA (509) KMART 2304 E NOB HILL BLVD YAKIMA, WA 9890 (509) MEMORIAL 402 S 2TH AVE YAKIMA, WA (509) NORTH STAR LODGE 808 N 39TH AVE YAKIMA, WA (509) SUMMITVIEW AVE YAKIMA, WA (509) W NOB HILL BLVD STE B YAKIMA, WA (509) N 9TH AVE YAKIMA, WA (509) ROSAUERS 40 S 72 AVE YAKIMA, WA (509) N 5TH AVE YAKIMA, WA (509) E MEAD AVE YAKIMA, WA (509) SUMMITVIEW AVE YAKIMA, WA (509) SHOPKO PHARMACY* 580 SUMMITVIEW AVE YAKIMA, WA (509) TERRACE VILLAGE HM 4040 TERRACE HEIGHTS DR YAKIMA, WA 9890 (509) TIETON VILLAGE DRUG * 3708 TIETON DR YAKIMA, WA (509) W YAKIMA AVE YAKIMA, WA (509) SUMMITVIEW AVE STE YAKIMA, WA (509) WAL-MART * 600 E CHESTNUT AVE YAKIMA, WA 9890 (509) WAL-MART * 6600 W NOB HILL BLVD YAKIMA, WA (509)

141 WASHINGTON HEMATOLOGY ONCOLOGY * 39 CASTLEVALE RD STE 20 YAKIMA, WA (509) WRAY'S CHALET THRIFTWAY * 5605 SUMMITVIEW AVE YAKIMA, WA (509) WRAY'S THRIFTWAY * 7200 W NOB HILL BLVD YAKIMA, WA (509) YAKIMA NEIGHBORHOOD 2 S 8TH ST YAKIMA, WA 9890 (509) YAKIMA VALLEY FARM WKRS CLINIC * 602 E NOB HILL BLVD YAKIMA, WA 9890 (866)

142 Mail Order Pharmacies You can get prescription drugs shipped to your home through our network mail order delivery program. Typically you should expect to receive your prescription drugs within 4 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at (TTY Relay: Dial 7-- ) from 8:00 a.m. to 8:00 p.m., 7 days a week. To get more information about the mail order pharmacy, please call our Customer Service department at (TTY Relay: Dial 7--) from 8:00 a.m. to 8:00 p.m., 7 days a week. Mail Order Pharmacies: Express Scripts PO Box St. Louis, MO

143 Home Infusion Pharmacies To get more information about the home infusion pharmacies, please call our Customer Service department at (TTY Relay: Dial 7--) from 8:00 a.m. to 8:00 p.m., 7 days a week. 42

144 Home Infusion Pharmacies BENTON COUNTY Kennewick OPTION CARE 7325 DESCHUTES AVE STE C KENNEWICK, WA (509) KING COUNTY KENT ACCREDO HEALTH GROUP TH AVE S KENT, WA (253) REDMOND CORAM SPECIALTY INFUSION SVCS 4935 NE 87TH ST STE 0 REDMOND, WA (425) SEATTLE OPTION CARE 3035 GATEWAY DR STE 3 SEATTLE, WA 9868 (800) SNOHOMISH COUNTY EVERETT OPTION CARE 820 EVERGREEN WAY EVERETT, WA (800) SPOKANE COUNTY SPOKANE CORAM SPECIALTY INFUSION SVCS 520 E NORTH FOOTHILLS DR SPOKANE, WA (509) WALGREENS INFUSION SERVICES 328 N ASH ST SPOKANE, WA 9920 (509) LIFECARE SOLUTIONS 703 E SPRAGUE AVE STE 3 SPOKANE VALLEY, WA (509) WHATCOM COUNTY BELLINGHAM INFUSION SOLUTIONS 34 PRINCE AVE STE B BELLINGHAM, WA (360) OPTION CARE 477 W HORTON RD BELLINGHAM, WA (800)

145 Long Term Care Pharmacies Residents of a long-term care facility may access their prescription drugs covered under Community HealthFirst through the facility s long-term care pharmacy or another network long-term care pharmacy. To get more information about the long term care pharmacies, please call our Customer Service department at (TTY Relay: Dial 7--) from 8:00 a.m. to 8:00 p.m., 7 days a week. 44

146 Long Term Care Pharmacies ASOTIN COUNTY CLARKSTON WASEM'S DRUG * 800 6TH ST CLARKSTON, WA (509) CLARK COUNTY CAMAS SURECARE RX 3400 SE 96TH AVE STE 00 CAMAS, WA (800) VANCOUVER CHS PHARMACY 6600 NE 2TH CT STE 03 VANCOUVER, WA (360) HI-SCHOOL PHARMACY 6926 NE FOURTH PLAIN BLVD VANCOUVER, WA 9866 (360) PROPAC PHARMACY 2606 NE 95TH ST VANCOUVER, WA (360) COLUMBIA COUNTY DAYTON ELK DRUG 76 E MAIN ST DAYTON, WA (509) COWLITZ COUNTY CASTLE ROCK CASTLE ROCK 7 ST AVE SW CASTLE ROCK, WA 986 (360) GARFIELD COUNTY POMEROY POMEROY 764 MAIN STREET POMEROY, WA (509) GRAYS HARBOR COUNTY MONTESANO VALU DRUG * 20 E PIONEER AVE MONTESANO, WA (360) ISLAND COUNTY CLINTON ISLAND DRUG * 042 STATE ROUTE 525 CLINTON, WA (360) OAK HARBOR ISLAND DRUG * 230 SE PIONEER WAY OAK HARBOR, WA (360) ISLAND DRUG LTC 3270 STATE ROUTE 20 STE B OAK HARBOR, WA (360) KING COUNTY AUBURN GENOA HEALTHCARE 4508 AUBURN WAY N STE A04 AUBURN, WA (253) QOL MEDS 2704 I ST NE AUBURN, WA (253)

147 BELLEVUE BELLEGROVE 200 2TH AVE NE STE A00 BELLEVUE, WA (425) BURIEN GENOA HEALTHCARE 20 SW 36TH ST RM 0 BURIEN, WA 9866 (206) KENT A AND H PHARMACEUTICAL SVCS 60 W MEEKER ST STE 20 KENT, WA (253) PROPAC PHARMACY* 702 S 220TH ST KENT, WA (855) UNITED CARE PHARMACY 8230 E VALLEY HWY KENT, WA (425) KIRKLAND EVERGREEN PHARMACEUTICAL TH AVE NE KIRKLAND, WA (425) REDMOND CONSONUS PHARMACY SERVICES 4729 NE 87TH ST REDMOND, WA (866) RENTON JOLLY'S PHARMACY 42 SW 43RD ST STE 20 RENTON, WA (425) PROVIDENCE INFUSION PHCY SVS 220 LIND AVE SW STE 30 RENTON, WA (425) SEATTLE BOB JOHNSONS 407 NW 85TH ST SEATTLE, WA 987 (206) GENOA HEALTHCARE 600 E OLIVE ST BLDG D SEATTLE, WA 9822 (425) KELLEY ROSS LTC PHARMACY 2324 EASTLAKE AVE E SEATTLE, WA 9802 (206) LOWRY'S PRESCRIPTIONS * 0330 MERIDIAN AVE N SEATTLE, WA 9833 (206) NORTHWEST MEDICATION MGMT 420 STONE WAY N SEATTLE, WA 9803 (206) OTTERSENS PHARMACEUTICAL 3023 GREENWOOD AVE N SEATTLE, WA 9833 (206) PREMIER LTC PHARMACY 68 S LANE ST STE 204 SEATTLE, WA 9844 (206) SURECARE RX 605 S 93RD ST STE B SEATTLE, WA 9808 (206) FIRCREST SCHOOL PHARMACY TH AVE NE SHORELINE, WA 9855 (206)

148 KITSAP COUNTY BREMERTON GENOA HEALTHCARE 5455 ALMIRA DR NE STE 329 BREMERTON, WA 983 (360) PORT ORCHARD STATE OF WA VETERANS HOME 4 BEACH DR E PORT ORCHARD, WA (360) LEWIS COUNTY CENTRALIA HALLS LONG TERM CARE PHCY 505 S TOWER AVE STE 2B CENTRALIA, WA 9853 (360) PIERCE COUNTY BUCKLEY RAINIER SCHOOL 220 RYAN RD BUCKLEY, WA 9832 (360) GIG HARBOR COSTLESS SENIOR SERVICES * ND AVE NW STE B GIG HARBOR, WA (253) LAKEWOOD BRIDGEPORT PHARMACY SERVICES 7424 BRIDGEPORT WAY W LAKEWOOD, WA (253) GENOA HEALTHCARE TH AVE SW STE 79 LAKEWOOD, WA (253) INTERNATIONAL PHARMACY LTC 228 BRIDGEPORT WAY SW LAKEWOOD, WA (253) TACOMA LINCOLN PHARMACY 82B S 38TH ST TACOMA, WA 9848 (253) MEGA TH ST S STE A TACOMA, WA (253) WESTERN STATE HOSP PHARMACY 960 STEILACOOM BLVD SW TACOMA, WA (253) UNIVERSITY PLACE FRANCISCAN HOSPICE LTC PHCY * 290 BRIDGEPORT WAY W UNIVERSITY PLACE, WA (253) SKAGIT COUNTY LA CONNER LA CONNER DRUG * 708 E MORRIS ST LA CONNER, WA (360) SNOHOMISH COUNTY EDMONDS EDMONDS PHCY STEVENS HLTH CTR TH AVE W STE 04B EDMONDS, WA (425)

149 PAVILION HOMECARE PHARMACY TH ST SW STE 00B EDMONDS, WA (425) EVERETT GENOA HEALTHCARE 3322 BROADWAY STE 230 EVERETT, WA 9820 (425) PAYLESS DRUG LTC PHARMACY SE EVERETT MALL WAY EVERETT, WA (425) SHIRAZ SPECIALTY PHARMACY 205 E CASINO RD STE B6 EVERETT, WA (425) MOUNTLAKE TERRACE MERCURY PHARMACY SERVICES TH AVE W MOUNTLAKE TERRACE, WA (425) SPOKANE COUNTY MEDICAL LAKE EASTERN STATE HOSPITAL 800 MAPLE MEDICAL LAKE, WA (509) LAKELAND VILLAGE SOUTH 2320 SALNAVE RD MEDICAL LAKE, WA (509) SPOKANE ST AVENUE 6 E ST AVE SPOKANE, WA (509) BATES PHARMACEUTICAL SVCS * 3704 N NEVADA STE B SPOKANE, WA (509) EVERGREEN PHARMACEUTICAL 350 E 3RD AVE SPOKANE, WA (509) NORTHWEST HEALTH SYSTEMS 07 S DIVISION ST STE 209 SPOKANE, WA (508) NORTHWEST HEALTH SYSTEMS * 288 N SULLIVAN RD BLDG 2E SPOKANE, WA 9926 (509) PROVIDENCO SACRED 0 W 8TH AVE SPOKANE, WA (509) RELIANT RX 20 N PINE ST STE 56 SPOKANE, WA (509) SPOKANE VALLEY PHARMERICA 24 N PINES RD STE 4 SPOKANE VALLEY, WA (509) STEVENS COUNTY COLVILLE PROVIDENCE HEALTH SERVICES WA * 200 E COLUMBIA AVE COLVILLE, WA 994 (509)

150 THURSTON COUNTY LACEY KIRK'S CHS PHARMACY 649 MARTIN WAY E LACEY, WA 9856 (360) PUGET PHARMACY SERVICES 75 CIRCLE LN SE LACEY, WA (360) OLYMPIA NORTHWEST SPECIALTY PHARMACY 908 4TH AVE E STE OLYMPIA, WA (360) PROVIDENCE MOTHER JOSEPH CTR * 3333 ENSIGN RD NE OLYMPIA, WA (360) WHATCOM COUNTY BELLINGHAM CUSTOM PRESCRIPTION SHOPPE * 33 E MAPLE ST STE 0 BELLINGHAM, WA B (360) HOAGLAND PHARMACY LTC 44 MEADOR AVE STE H02 BELLINGHAM, WA (360) WHITMAN COUNTY PULLMAN SID'S LTC PHARMACY 825 SE BISHOP BLVD STE 30 B PULLMAN, WA 9963 (509) YAKIMA COUNTY SELAH YAKIMA VALLEY SCHOOL 609 SPEYERS RD SELAH, WA (509) TOPPENISH GIBBONS PHARMACY* 7 S TOPPENISH AVE TOPPENISH, WA (509) YAKIMA CONSULTING AND PHARMACY SVCS 22 S 40TH AVE YAKIMA, WA (509) GENOA HEALTHCARE 402 S 4TH AVE YAKIMA, WA (509) RIVER VILLAGE PHARMACY 3708 TIETON DR YAKIMA, WA (509) YAKIMA VLY MEMORIAL HOSP PHCY 28 TIETON DR YAKIMA, WA (509)

151 Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies/ Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through Community HealthFirst s pharmacy network. Those other than Native Americans and Alaska Natives may be able to access these pharmacies under limited circumstances (i.e., emergencies). To get more information about the I/T/U Indian Health Program, please call our Customer Service department at (TTY Relay: Dial 7--) from 8:00 a.m. to 8:00 p.m., 7 days a week. 50

152 I/T/U Pharmacies CLALLAM COUNTY NEAH BAY SOPHIA TRETTEVICK INDIAN HLTH HIGHWAY 2 CLINIC RD NEAH BAY, WA (360) FERRY COUNTY INCHELIUM INCHELIUM COMMUNITY CLINIC INCHELIUM-KETTLE FALLS HWY INCHELIUM, WA 9938 (509) GRAYS HARBOR COUNTY TAHOLAH ROGER SAUX HEALTH CENTER 407 CONNUX ST TAHOLAH, WA (360) KING COUNTY SEATTLE SEATTLE INDIAN HEALTH BOARD 6 2TH AVE S SEATTLE, WA 984 (206) MASON COUNTY SHELTON KAMILCHE PHARMACY 90 SE KLAH CHE MIN DR SHELTON, WA (360) OKANOGAN COUNTY NESPELEM COLVILLE INDIAN HEALTH CTR AGENCY CAMPUS HWY 55 NESPELEM, WA 9955 (509) OMAK OMAK HEALTH STATION PHARMACY 67 BENTON ST OMAK, WA 9884 (509) PIERCE COUNTY TACOMA PUYALLUP TRIBAL HEALTH 2209 E 32ND ST BLDG 5 TACOMA, WA (253) SNOHOMISH COUNTY TULALIP TULALIP PHARMACY TH AVE NE STE A TULALIP, WA 9827 (360) STEVENS COUNTY WELLPINIT DAVID C WYNECOOP MEM CLNC 6203 AGENCY LOOP RD WELLPINIT, WA (509) THURSTON COUNTY OLYMPIA NISQUALLY TRIBAL PHARMACY 486 SHE NAH NUM DR SE OLYMPIA, WA 9853 (360) WHATCOM COUNTY BELLINGHAM LUMMI TRIBAL HEALTH CENTER 2592 KWINA RD BELLINGHAM, WA (360)

153 YAKIMA COUNTY TOPPENISH YAKAMA INDIAN HLTH CTR PHCY 40 BUSTER RD TOPPENISH, WA (509)

154 2TH STREET CHC ST AVENUE.. 29,48 A AND H PHARMACEUTICAL SVCS A AND H PHARMACEUTICAL SVCS ABERDEEN HEALTH MART 9 ACCESS ACCREDO HEALTH GROUP ADVENTIST HEALTH COMMUNITY * AFH PHARAMCY *. 0 AHP. 0 AKERS UNITED DRUG* ALBERTSON'S * ,92,94,96,99,00,09-,4-7,23,25-29,32,34,35,38, 39 ALLENMORE OUTPATIENT... 7 ALPINE INTEGRATED MEDICINE * APOTHECARY SHOPPE * ARLINGTON CHC... 2 ARLINGTON... 2 ASSURED PHARMACY* BALLARD PLAZA... 0 BARTELL DRUGS *.93-02,07,08,4,7, 9,22,23,25-28 BATES PHARMACEUTICAL SVCS *... 29,48 BATES BEALL'S... 6 BELLEGROVE... 93,46 BETHEL BI-MART... 82,86,88,89,,28, 35,38,39 BOB JOHNSONS.. 02,46 BREWSTER HEALTH MART DRUG *... 3 BRIDGEPORT PHARMACY SERVICES BROADWAY CHC BUCK PAVILION CABRINI MEDICAL TOWER PHCY * CASTLE ROCK... 88,45 CATHLAMET CAVALLINI'S... CEDAR VILLAGE... 2 CENTRAL WA FAMILY MEDICINE * CENTRAL WASHINGTON HOSP PHCY * CHAS*... 28,29,32 CHAS DENNY MURPHY CHAS CHAS-NHOS * CHAS-WASEM * CHENEY OWL HEALTH MART PHCY * CHESTERFIELD CHINOOK PHARMACY CHS PHARMACY CHUCK'S DRUGS * 4 CHUNG... 7 CITY CENTER DRUG *... 9 CLARKSTON HEIGHTS CLE ELUM DRUG * COLTON... 2 COLUMBIA BASIN HEMATOLOGY * COLUMBIA COLUMBIA VALLEY COMM H PHCY * COLVILLE INDIAN HEALTH CTR... 5 COMM HEALTH CARE HILLTOP PHCY *... 7 COMMUNITY HEALTHCARE... 7 CCONNELL FAMILY CLINIC CONSONUS PHARMACY SERVICES CONSULTING AND PHARMACY SVCS. 49 COPE'S... 6 CORAM SPECIALTY INFUSION SVCS COST LESS PRESCRIPTIONS *. 7 53

155 COST PHARMACY- FIRCREST *... 7 COSTCO * 82,85,86,90,95,96,98,0 3,08,,4,6,8, 20,23,26,28,29, 33,35,36,38 COSTLESS SENIOR SERVICES *... 4,47 COUNTRY DOCTOR COMMUNITY CLN * 03 COVINGTON MULTICARE CLINIC * CROWN DRUG *... 9 CUSTOM PRESCRIPTION SHOPPE *... 36,49 DARRINGTON DAVENPORT GOOD NEIGHBOR PHCY * 2 DAVID C WYNECOOP MEM CLNC... 5 DEACONESS OUTPATIENT DENSOW'S DES MOINES DRUG DOANE'S VALLEY DONG NAI PHARMACY* DONS 92 DOWNTOWN PUBLIC HLTH CNTR PHCY. 03 DUPONT... 4 DUVALL FAMILY DRUGS * E WENATCHEE FOOD PAVILION PHCY * EAST VALLEY EASTERN STATE HOSPITAL EDMONDS EDMONDS PHCY STEVENS HLTH CTR EDMONDS WELLNESS CLINIC * ELFERS-LYON ELK DRUG... 88,45 ELLENSBURG DOWNTOWN HM PHCY *... ELLENSBURG... ELMA HEALTH MART... 9 EVERETT FOOT CLINIC * EVERGREEN INTEGRATIVE MEDICINE * EVERGREEN NATUROPATHIC *.. 29 EVERGREEN PHARMACEUTICAL... 46,48 EVERGREEN EVERGREEN PROF CTR FAIRFIELD OWL FAIRHAVEN FAIRWAY DRUG *.. 37 FAMILY HEALTH CENTERS *... 3 FAMILY MED CTR FAMILY... 20,22 FAMILY WELLNESS CENTER PC * FEDERAL WAY FIESTA FIFTH AND BROWNE FIRCREST PHARMACY, *... 4 FIRCREST SCHOOL PHARMACY FRANCISCAN HOSPICE LTC PHCY *... 20,47 FRANCISCAN... 6 FRANCISCAN PHARMACY AUBURN* FRANCISCAN PHARMACY FIRST AVE * FRANCISCAN PHARMACY ST CLARE, *... 5 FRANCISCAN PHARMACY ST JOSEPH *... 8 FRANCISCAN PHARMACY TACOMA*... 8 FRANCISCAN PHCY BONNEY LAKE *... 4 FRANCISCAN PHCY ST ANTHONY *... 4 FRED MEYER... 82,83,85,86,89,90,93, 96-00,03,09,0, 2, 4,6-8,20, 22, 23, 25-27, 30, 32, 33, 36,39 FRIDAY HARBOR DRUG * GARFIELD PHARMACY

156 GENOA HEALTHCARE GIBBONS PHARMACY*... 38,49 GODFREYS GOOD... 5 GOOD SAMARITAN BEHAVIORAL HLTH *... 6 GROSS DRUG * HAGGEN FOOD &... 3,2,22,26,28, 36 HAGGEN FOOD AND DRUG * HAGGEN PHARMACY* HALLS DRUG CENTER*... HALLS LONG TERM CARE PHCY HARBOR DRUG *... 9 HARBORVIEW MEDICAL CENTER * HART AND DILATUSH HAWKS PRAIRIE HEALTH MART PHCY * HEALTHPOINT AUBURN PHARMACY* HEALTHPOINT BOTHELL PHARMACY* HEALTHPOINT CENTRAL FILL PHCY * HEALTHPOINT FEDERAL WAY PHCY* HEALTHPOINT KENT HEDDEN'S HIGHLAND... 96,23 HILLTOP... 2,26 HI-SCHOOL PHARMACY... 86,89,,45 HOAGLAND PHARMACY LTC HOAGLAND PHARMACY SOUTH *... 2 HOAGLAND'S PHARMACY* HOLLY PARK HORIZON PHARMACY* HOWARD'S DRUG *38 INCHELIUM COMMUNITY CLINIC... 5 INFUSION SOLUTIONS INTEGRATIVE FOOT AND ANKLE CTR * INTERFAITH INTERNATIONAL COMM HLTH SVCS * INTERNATIONAL... 5 INTERNATIONAL PHARMACY LTC ISLAND DRUG * 92,45 JIM'S... 85,95 JODI BERGS INTGRTVE FMLY HLTH* JOLLY'S PHARMACY... 00,46 KAMILCHE PHARMACY... 5 KATTERMAN'S SAND POINT PHCY * KELLEY ROSS LTC PHARMACY... 03,46 KETTLE FALLS HEALTH MART PHCY * KING PLAZA KIRK'S CHS PHARMACY KIRK'S... 6 KITSAP... 0 KMART... 92,2,8,30,39 KUSLER'S PHARMACY* L J'S FURNESS DRUG* LA CONNER DRUG *... 2,47 LAFFERRY'S LAKE CHELAN LAKE SPOKANE LAKELAND VILLAGE LAKEMONT LAKEWOOD... 5 LAURA J HIEB ND * 00 LEGACY SALMON CREEK APOTHECARY* LIDGERWOOD OWL HM

157 LINCOLN COUNTY HLTH MRT PHCY *. 2 LINCOLN PHARMACY*... 8,47 LINDEMAN PAVILION LINDS COUPVILLE LIND'S FREELAND LOGAR LONG BEACH... 3 LOPEZ ISLAND PHARMACY LOURDES WEST PASCO LOWRY'S PRESCRIPTIONS *... 03,46 LUKE'S LUMMI TRIBAL HEALTH CENTER.. 5 LYNNWOOD CHC MAI LINH PHARMACY*... 8 MALLEYS COMPOUNDING MAPLE LEAF MARKS CAMANO MARTIN'S SOUTHGATE DRUG * MARY BRIDGE RETAIL CLINIC PHCY *... 8 MCQUINN NATUROPATHIC *.. 23 MEDIART FAMILY CLINIC * MEDICAL ARTS ASSOCIATES PS * MEDICAL CENTER... 96,24,34 MEDICAL LAKE OWL MEDICAL MALL MEDICAL ONCOLOGY ASSOCIATES PS *. 30 MEDICINE MAN LIBERTY LAKE * MEDICINE SHOPPE... 90,2,28,30,32 MEGA... 8,47 MEMORIAL MERCURY PHARMACY SERVICES MERIDIAN PHARMACY* METMEDS PHARMACY* MICHAEL K WOO ND * MILL CREEK MILL PLAIN MEDICAL AND PHCY * MOLINA HEALTHCARE* MT RAINIER CLINIC WHOLISTIC *... 4 MULTICARE BONNEY LAKE 4 MULTICARE CLINIC... 8 MULTICARE GIG HARBOR PHARMACY*... 5 MULTICARE GOOD SAMARITAN PHCY *... 6 MULTICARE MEDICAL CENTER PHCY *... 8 MULTICARE WESTGATE... 8 NATURAL HEALTH AND EDU SVCS *... 8 NATURAL HEALTHCARE NORTHWEST * NATURAL OPTIONS HEALTH CLINIC *... NATUROPATHIC MEDICINE * NAVOS * NEIGHBORCARE HEALTH * NEIL'S... 2 NGUYENS PHARMACY AND GIFTS * NICHOLSON'S SUMNER... 7 NISQUALLY TRIBAL PHARMACY... 5 NORTH PUBLIC HEALTH CTR PHCY NORTH STAR LODGE NORTHWEST HEALTH SYSTEMS *... 30,48 NORTHWEST KIDNEY CENTER PHCY * NORTHWEST MEDICATION MGMT NORTHWEST PRESCRIPTION * NORTHWEST SPECIALTY PHARMACY

158 NW NATUROPATHY AND ACUPUNCTURE * OCEAN PARK... 3 OCEAN SHORES O'HANA WELLNESS CENTER * OKANOGAN DOUGLAS HOSPITAL PHCY *. 3 OKANOGAN VALLEY... 3 OLYMPIC DRUG * OLYMPIC PHCY AND HEALTH CARE *... 5 OMAK HEALTH STATION PHARMACY... 5 OMAK... 3 ONURI 96 OPTION CARE OSTROM DRUG AND GIFT * OTHELLO FAMILY CLINIC OTTERSENS PHARMACEUTICAL46 OWL TRI-STATE PACIFIC DRUGS *.. 04 PACIFIC MEDICAL CENTER PHCY PACIFIC NW SPECIALTY PACMED CLINIC PHARMACY 98,00,04 PAIN ASSOCIATES OF WASHINGTON * PARAMOUNT PARKLAND MARKETPLACE... 8 PARK'S PARTNER ONCOLOGY*... 6 PAVILION HOMECARE PHARMACY PAVILION PHARMACY* PAYLESS DRUG LTC PHARMACY... 30,48 PEACE HEALTH SOUTHWEST PHCY * PEACEHEALTH ST JOHN MED CTR * PECKENPAUGH DRUG, * PENINSULA COMM HTLH SVCS PHCY *... 0 PENINSULA COMMUNITY HEALTH SVS *... 09,0 PHARM A SAVE MONROE * PHARMACA INTEGRATIVE.. 00,04 PHARMACARE SPECIALTY PHCY *04 PHARMACY CARE * PHARMACY PLUS *. 94 PHARM-A-SAVE PHARMERICA PHSW PHARMACY AT MEDICAL CTR * PHYSICAL REHABILITATION * 24 PIONEER MED CENTER... 9 PLANNED PARENTHOOD OF GRT NW PHCY * PLATEAU COMMUNITY POMEROY... 90,45 POULSBO COMPOUNDING... 0 PREMIER LTC PHARMACY PROPAC PHARMACY*... 97,45,46 PROVIDENCE CENTRALIA HOSPITAL... PROVIDENCE HEALTH SERVICES WA *... 33,48 PROVIDENCE INFUSION PHCY SVS PROVIDENCE MILL CREEK PHCY * PROVIDENCE MOTHER JOSEPH CTR*... 34,49 PROVIDENCE PHARMACY MONROE* PROVIDENCE ST MARY PROVIDENCO SACRED... 30,48 PUGET PHARMACY SERVICES PUGET SOUND... 8 PURDY COST LESS PRESCRIPTIONS *. 5 PURITY INTEGRATIVE HEALTH CTR *

159 PUYALLUP TRIBAL HEALTH... 5 QFC... 85,86,92,94,95,97-00,05,2,23,24, 27,33,45 QUE ARESTE ND *. 05 RAINIER SCHOOL.. 47 RALPH'S THRIFTWAY RANKOS STADIUM... 8 RAYS READY MEDS RELIANT RX REPUBLIC DRUG STORE ,87-97,99-0,05,08-8,20-28,30,32-39 RITZVILLE DRUG * RIVER VILLAGE PHARMACY RIVERPOINT RIVERSTONE FAMILY HEALTH PHCY * ROGER SAUX HEALTH CENTER... 5 ROSAUERS... 30,3,39 ROY'S HEALTH MART... 3 RUMED... 9 RXPRESS PHARMACY*... 4 RXTRA CARE PHCY VIEW RIDGE * SAAR'S MARKETPLACE PHARMACY, *83-85,87-0,05,06,08-3,5,7,9-29,3-39 SAGENS... 3 SAM'S CLUB *... 93,0,06 SAVON SEA MAR CHC PHARMACY... 06,2 SEA MAR COMMUNITY HEALTH CTRS * SEATTLE CANCER CARE ALLIANCE *.. 06 SEATTLE CHILDRENS HOSPITAL *... 94,06 SEATTLE INDIAN HEALTH BOARD... 5 SEATTLEMEDS SEEBER'S HEALTH MART *... 3 SELAH SAVE ON FOODS SEVAN SHIRAZ SPECIALTY PHARMACY SHIRAZ SPECIALTY SHOPKO PHARMACY* 83,9,3,34,35,37-39 SHORELINE NATURAL MEDICINE * SID'S LTC PHARMACY SID'S 37 SIMON WELLNESS * SIXTH AVE MEDICAL... 3 SKAGIT REGIONAL CLINICS PHCY *... 2 SKAGIT VALLEY HOSP... 2 SKAGIT VALLEY HOSPITAL OP PHCY *... 2 SMOKEY POINT SNOQUALMIE VILLAGE PHARMACY* SOPHIA TRETTEVICK INDIAN HLTH... 5 SOUND HOLISTIC HEALTH * SOUTH BEND... 3 SOUTH PARK... 0 SOUTHGATE... 9 SPOKANE FALLS FAMILY CLIN PHCY *... 3 SRC RIVERBEND... 2 ST JOHN PHARMACY* STATE OF WA VETERANS HOME. 47 SULTAN PHARMACY AND NAT CARE * SUMAS DRUG * SUNSET PLAZA... 0 SUPER ONE..,33 SURECARE RX45,46 SWANSON OWL... 9 SWEDISH FIRST HILL SWEDISH ISSAQUAH RETAIL PHCY * SWEDISH ORTHOPEDIC INST PHCY *

160 SWEDISH PHARMACY CHERRY HILL * TACOMA MEDICAL CENTER... 9 TALLMANS TARGET... 83,87,89,96-98,00,0,07,08, 4-7,9,24-26,3,34,37 TCCH. 90 TEKOA TERRACE VILLAGE HM THE COMPOUNDING APOTHECARY * THE FALLS PHCY UNITED DRUGS * THE NATURAL PATH TO HEALING * THE PRESCRIPTION PAD. 0 THE VANCOUVER CLINIC * THREE MOON CLINIC* THRIFTY PAYLESS * TICK KLOCK DRUGS * TIETON VILLAGE DRUG * TIM'S 35 TOP FOOD AND DRUG* 93,98,08,09,7,9, 23,27,34 TRADING COMPANY TREE OF HEALTH INTEGRATIVE * TRI-AREA PHARMACY* TULALIP PHARMACY... 5 TWIN HARBOR DRUG* ULRICH VALLEY HEALTH MART PHCY... 3 UNION CENTER UNITED CARE PHARMACY... 98,46 UWMC AMBULATORY VALLEY DRUG * VALLEY HEALTH MART DRUG * VALLEY MISSION HOMECARE PHCY * VALU DRUG * VANCOUVER CLINIC VASHON PHARMACY VILLAGE PHARMACY* VISTA ONCOLOGY * VITAL THERAPEUTICS* ,87-99,0,07-2,4,5,7,9-27,29,3-37,39 WAL-MART * ,88-96,0,0,2,5, 7,9,2,22,24, 26, 28,32-35,37-39 WASEM'S DRUG *... 82,45 WASHINGTON CTR FOR PAIN MGMT * WASHINGTON HEMATOLOGY ONCOLOGY * WELL LIFE LATAH WELL LIFE LIBERTY LAKE * WENATCHEE CLINIC WESTERN STATE HOSP PHARMACY. 47 WFHC PHARMACY.. 9 WHITE CENTER WIND RIVER... 2 WINSLOW DRUG *. 09 WOODINVILLE MED CTR PHCY * WRAY'S CHALET THRIFTWAY * WRAY'S THRIFTWAY * WSU HEALTH AND WELLNESS SVC *.. 38 YAKAMA INDIAN HLTH CTR PHCY YAKIMA NEIGHBORHOOD HEALTH * YAKIMA NEIGHBORHOOD YAKIMA VALLEY FARM WKRS CLINIC * YAKIMA VALLEY SCHOOL YAKIMA VALLY FARM WORKERS * YAKIMA VLY FARM WRKRS CLINIC * YAKIMA VLY MEMORIAL HOSP PHCY YAUGER PARK YOKES *... 83,84,90,28,29, 32,33 59

161 Community Health Plan of Washington is a Coordinated Care Plan with a Medicare Advantage contract. Enrollment in Community Health Plan of Washington depends on contract renewal. 60

162 Offered by Prospective Members: Current Members: (TTY Relay: Dial 7--) 8:00 a.m. to 8:00 p.m., 7 days a week 720 Olive Way, Suite 300 Seattle, WA

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