Effective 11/28/2018 4 10 ges.com

[Pages:3]Effective 11/28/2018

Guide to low-cost prescriptions

Low-cost drugs available starting at:

$4 $10

30 day 90 day

prescriptions

Check pharmacy counter for details. *

Diabetes

HYDRALAZINE 10MG, 25MG, 50MG

90

270

HYDROCHLOROTHIAZIDE 12.5MG,

30

90

$4

$10

25MG, 50MG TAB

30 Day Qty 90 Day Qty HYDROCHLOROTHIAZIDE 12.5MG CAP 30

90

GLIMEPIRIDE 1MG, 2MG, 4MG

30

90

INDAPAMIDE 1.25MG, 2.5MG

30

90

GLIPIZIDE 5MG, 10MG

60

180

ISOSORBIDE MONONITRATE ER

30

90

METFORMIN 500MG, 850MG, 1000MG 60

180

30MG, 60MG

METFORMIN ER 500MG TAB

120

360

LISINOPRIL 2.5MG, 5MG, 10MG,

30

90

METFORMIN ER 750MG TAB

60

180

20MG, 30MG

LISINOPRIL/HCTZ 20/25MG

30

90

$9

$24

30 Day Qty 90 Day Qty

LOSARTAN 25MG, 50MG, 100MG LOSARTAN/HCT 50/12.5MG TAB

30

90

30

90

GLIPIZIDE ER 2.5MG, 5MG, 10MG

30

90

METOPROLOL TART 25MG, 50MG, 100MG 60

180

GLYBURIDE/METFORMIN

60

180

RAMIPRIL 2.5MG, 5MG, 10MG

30

90

2.5/500MG, 5/500MG

TRIAMTERENE/HCTZ

30

90

PIOGLITAZONE 15MG, 30MG, 45MG

30

90

37.5/25MG, 75/50MG TAB

WARFARIN 1MG, 2MG, 2.5MG, 3MG,

30

90

Heart

4MG, 5MG, 6MG, 7.5MG, 10MG

Cholesterol

$4

$10

30 Day Qty 90 Day Qty

Heart Health & Blood Pressure

$9

$24

30 Day Qty 90 Day Qty

SIMVASTATIN 10MG, 20MG, 40MG

30

90

AMIODARONE 200MG

30

90

BISOPROLOL 5MG

30

90

Cholesterol

$9

$24

30 Day Qty 90 Day Qty

CILOSTAZOL 50MG, 100MG CLOPIDOGREL 75MG

60

180

30

90

ATORVASTATIN 10MG, 20MG, 40MG

30

90

DIGOXIN 0.125MG, 0.25MG

30

90

FENOFIBRATE 145MG

30

90

DILTIAZEM ER 120MG CAP (24 HOUR) 30

90

GEMFIBROZIL 600MG

60

180

DILTIAZEM 30MG, 60MG, 120MG

60

180

DOXAZOSIN 1MG, 2MG, 4MG, 8MG

30

90

Heart Health & Blood Pressure

$4

$10

30 Day Qty 90 Day Qty

ENALAPRIL 2.5MG, 10MG, 20MG IRBESARTAN 150MG, 300MG

30

90

30

90

AMLODIPINE 2.5MG, 5MG, 10MG

30

90

METOPROLOL ER 25MG, ER 50MG

30

90

ATENOLOL 25MG, 50MG, 100MG

30

90

MINOXIDIL 10MG TAB

30

90

BENAZEPRIL 20MG, 40MG

30

90

TORSEMIDE 20MG, 100MG

30

90

CARVEDILOL 3.125MG, 6.25MG,

60

180

TRIAMTERENE/HCTZ 37.5/25MG CAP

30

90

12.5MG, 25MG

VALSARTAN/HCTZ 160/12.5MG, 160/25MG 30

90

CLONIDINE 0.1MG, 0.2MG, 0.3MG

60

180

VERAPAMIL ER 120MG, 180MG, 240MG TAB 30

90

FUROSEMIDE 20MG, 40MG, 80MG

30

90

Continued

*Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher or vary in some states including, but not necessarily limited to, CA and MN. For important information regarding Walmart's Patient accessibility program, including the availability of language interpretive services, please see the last page.

Prepackaged drugs are covered only in unit sizes specified on Drug List (back page). Other restrictions may apply. See Program Details or your Walmart Pharmacist for details.

Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from such manufacturers are in stock at the dispensing pharmacy.

?2018 Walmart Apollo, LLC | Page 1 of 3 Art Revised 11/09/2018 11:14AM

Effective 11/28/2018

Mental Health

AMITRIPTYLINE 10MG, 25MG, 50MG, 75MG BUSPIRONE 5MG, 10MG CITALOPRAM 10MG, 20MG, 40MG FLUOXETINE 10MG TAB FLUOXETINE 20MG, 40MG CAP LAMOTRIGINE 100MG, 200MG LAMOTRIGINE 25MG, 150MG LITHIUM CARB 300MG CAP NORTRIPTYLINE 10MG, 25MG, 50MG PAROXETINE 20MG, 30MG RISPERIDONE 0.25MG, 0.5MG, 1MG, 2MG, 3MG, 4MG TRAZODONE 50MG, 100MG, 150MG TRIHEXYPHENIDYL 2MG TAB

$4

$10

30 Day Qty 90 Day Qty

30

90

60

180

30

90

30

90

30

90

30

90

60

180

60

180

30

90

30

90

30

90

30

90

60

180

$9

$24

30 Day Qty 90 Day Qty

AMANTADINE 100MG

60

180

BUPROPION 75MG, 100MG

60

180

BUPROPION ER/SR 100MG,

60

180

150MG, 200MG TAB

BUPROPION XL 150MG TAB

30

90

CARB/LEVO 10/100MG, 25/100MG

90

270

DIVALPROEX DR 250MG TAB

60

180

DONEPEZIL 5MG, 10MG

30

90

DULOXETINE 20MG, 30MG, 60MG

30

90

ESCITALOPRAM 5MG, 10MG, 20MG

30

90

LEVETIRACETAM 500MG

60

180

LITHIUM CARB ER 300MG, 450MG TAB 60

180

MIRTAZAPINE 15MG, 30MG, 45MG

30

90

OLANZAPINE 2.5MG, 5MG, 7.5MG,

30

90

10MG, 15MG, 20MG

OXCARBAZEPINE 300MG

60

180

PAROXETINE 40MG

30

90

PRAMIPEXOLE 0.125MG, 0.25MG,

30

90

0.5MG, 1MG, 1.5MG

PRIMIDONE 250MG TAB

60

180

PRIMIDONE 50MG TAB

30

90

QUETIAPINE 25MG, 50MG, 100MG,

30

90

200MG, 300MG

ROPINIROLE 0.25MG, 0.5MG, 1MG,

30

90

2MG, 3MG, 4MG

SERTRALINE 25MG, 100MG

30

90

TOPIRAMATE 25MG, 50MG, 100MG, 200MG 60

180

TRIHEXYPHENIDYL 5MG TAB

60

180

VENLAFAXINE 37.5MG TAB

60

180

VENLAFAXINE 75MG, 100MG TAB

60

180

VENLAFAXINE ER 37.5MG,

30

90

75MG, 150MG CAP

ZONISAMIDE 50MG CAP

60

180

Other Therapeutic Category

Digestion METOCLOPRAMIDE 5MG, 10MG

$4

$10

30 Day Qty 90 Day Qty

90

270

Digestion OMEPRAZOLE 20MG CAP OMEPRAZOLE DR 40MG

$9

$24

30 Day Qty 90 Day Qty

30

90

30

90

Thyroid LEVOTHYROXINE 25MCG, 50MCG, 75MCG, 88MCG 100MCG, 112MCG, 125MCG, 137MCG, 150MCG, 175MCG, 200MCG

$4

$10

30 Day Qty 90 Day Qty

30

90

Vitamin & Nutrition FOLIC ACID 1MG

$4

$10

30 Day Qty 90 Day Qty

30

90

Vitamin & Nutrition FOLBEE TAB

$9

$24

30 Day Qty 90 Day Qty

30

90

Family Planning NORETHINDRONE TAB 0.35 MG SPRINTEC 28 TAB 28 DAY TRI-SPRINTEC TAB

$9

$24

30 Day Qty 90 Day Qty

28

84

28

84

28

84

*Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher or vary in some states including, but not necessarily limited to, CA and MN. For important information regarding Walmart's Patient accessibility program, including the availability of language interpretive services, please see the last page.

Prepackaged drugs are covered only in unit sizes specified on Drug List (back page). Other restrictions may apply. See Program Details or your Walmart Pharmacist for details.

Program pricing may be limited to select manufacturers of a covered drug and is available as long as supplies from such manufacturers are in stock at the dispensing pharmacy.

?2018 Walmart Apollo, LLC | Page 2 of 3 Art Revised 11/09/2018 11:14AM

Effective 11/28/2018

Walmart's Prescription Program Details

W1. aWlamlmaartr'stP'sresPcrripetisoncPrriopgrtaimo(ntheP"rProoggrrama"m) is aDvaeilatbaleialtsall Walmart and Neighborhood Market pharmacies in the United States ("Walmart Retail 1. PWhaalmrmarat'csiPerse"s)c,reipxtcioenpPtriongrNamor(tthheD"aPkroogtraa,mas")siseatvfaoilratbhlebaetlaollwWianlmSaerct tainodns 3. The

PNreoigghrbaomrhiosoadlsMoaarkveatilpahbalremtahcrioesuignhthWe UalnmiteadrtSMtataeisl S("eWravlimcear(t"RWetaaliml PahratrmMaaciileSs"e),rvice"), aesxcseepttfionrNthorbtheDloawkoitna,Saescsettiofnor4th. below in Sections 3 and 4. The Program is also available

2. TthhreouPgrhoWgraalmmarat pMpaliileSserovnicley(t"Wo aclmeratratiMnagileSneervricice"d),rausgssetaftorctohmbemlowoninlySepcrteiosncr5i.bed 2. dTohesaPgroegsr.aHmigahppelriedsoosnalygteoscceortsatinmgeonreer.icYodruumgsaayt coobmtaminonalylipsrteoscfrgibeendedroiscagdersu.gHsigahnedr

ddossaaggeesscocsotvmeorered. uYonudmeraythoebtPairnoaglrisatmof(gtehnee"riRcedtraugilsDanrudgdoLsiasgt"e)s oconvweraeldmuanrdte.crothme or aPtroWgraalmmatrtWRaelmtariltPRhetaarilmPahcariemsa.cTiehse(tRhet"aRiel tDairluDgruLgisLtismt")aayncdhtharnogueghanWdalamlsaort mMaaiyl vary bSyersvticaete(t.hNeo"Mt aill SfeorrvmiceulDatruiognLsisot"f) aondWruaglm(afortr.ceoxmaomrpatleW, aelnmtaerrtiRc-ectaoilaPtheadr,meaxctieesn. dTehde or tRimetaeidl DrreulgeaLsiset afnodrmMuailaSteiorvnicse) aDrreugcLoivstemready cuhnadneger tahnde aPlsroomgraaymva.rPyrboygsrtatme. pNroictianllg not afovramilaublalteiownshoefnaadrcuogv(eforreedxadmrupgle,isendtiesprice-ncsoeatdeda,sepxaterntdoefdaocr otimmepdoruenledas. e

3. UfonrmdeurlatthioensP)raoregcroavmeraetdWunadlemr tahret PRreotgarialmP.hParromgraacmiepsr,ic$i4ngisnotht eavpairlaicbelefwohreunpato a 3c0ov-edraeyd sdurupgpilsydoisfpcenesretdaianscpoarvteorfeadcgomenpeoruincdd. rugs at commonly prescribed dosages

3. (Uthndee"r$th4eRPerotagirlaPmraotgWraamlm"a)r.t$R1e0taisil Pthhearpmraiccieso, $f4ais9t0h-edparyicseufporpulypotof ac3e0rt-adiany csuopvpelyreodf gceerntaeirniccodvreuregds gaetnceorimc dmruognslaytpcoremsmcroinbleydprdeoscsraibgeedsd(otshaege"s$(1t0heR"e$t4aiRlePtraoilgPrroagmra"m)."N).ot all d$1r0ugissthceopvreicreedofbay9t0h-eda$y4suRpepltyaoilfPcreortgarinamcovaerreedcogevneerreicddbruygtshaet c$o10mmProonglyrparmes.cPrirbiecdes fdoorsaqgueasn(tthiteie"s$1b0eRtewtaeilePnroag3ra0m-d")a. yNsoutpapll ldyruagnsdcoav9e0re-ddbayytshuep$p4lyReotfaidl Pruroggsracmovaerered by bcoovtehrethdeby$t4heR$e1t0aPilrPogroragmr.amPricaensdfo$r10quRanettitaieilsPbreotwgreaemn aa3r0e-dparyosruaptpeldy abnadsaed90o-ndatyhe $4 Psurpopglyraomf dprurgicsec,obveurtewd ibllynbootthetxhcee$e4dR$e1t0ai.l PPrroicgerasmfoarndqu$1a0nRtiettieaisl Pgrroegartaemratrheapnroara9t0ed-day sbuapsepdlyonofthder$u4gPsrcoogvraemrepdricbey, tbhuet w$i1ll0noRteetxaciel ePdro$1g0r.aPmricaersefoprrqouraantteitdiebs agsreeadteornthtahnea$10 P9r0o-dgaryasmuppprlyicoef.dUrungdsecrotvhereedPrboygthraem$10atReWtaaillmPraorgtraRmetaareil pPrhoarartmedabcaiesesd, $o9n itsheth$e10price fc$oPFSo2oteorrho4cvrgteuepiirorrprsaienccmttdiho6nop.egvgarepeipcr3onree0lie.icdc-rPeideigrcsoaoerrdyfneartasleaueurt9gdipinc0sppg-dralitdyctroauioncpyggofrssemcisupaenpamtrcoptckotaloayanignmvloeayFdifmlpaacdbmroreelunerisglltuycysanriP(pdinsbleruaeFercndashtnhcmadeirsniioPbltgysureoabaPdggenlrsaedda,nsomvMni(satfialneoshgrgnoeep'rsas"rbne$h(op9tdethataRMcleelktesae"h)tg$,naesa2'iedsnl4ePdhdRrreouoeagtgtlhstar.heailrman"d).

4. PUrnodgerathme"P)r.oNgoratmalaltdWrualgmsarctoRveetraeildPhbayrmthaceie$s9, $R9eisttahiel Ppriocegrfoarmupartoeac3o0v-edraeydsubpypltyhoef $24 Pcerortgairnawmo.mPernic'sehsefaoltrhqanudanothiteier csobvetrewdegeenneari3c0d-rudgasyastucpomplmy oannldy pare9s0cr-idbeadydsouspapgleys of d(trhueg"s$9coRveetariel Pdrobgyrabmo"t)h. $t2h4eis$t9heRpertiaceil fPoroag9r0a-mdayansudpp$l2y4ofRcerttaaiilnPwroomgreanm's haeraelthparondrated boathseerdcoovnertehdeg$e9nePrircodgrruagms atpcroicmem, bounltywpriellsncroibteedxdcoeseagde$s2(t4h.eP"r$i2c4eRseftoarilqPuroagnrtaimti"e)s. gNroetaatlel drrtuhgasncoave9r0ed-dbayythseup$9pRlyeotafildPruoggrsamcoavrerceodvebreydtbhyet$he24$2R4eRteatialilPPrrooggraamm. aPreices pforroqruaatnetditibeas sbeedtwoenentha e30$-2d4ayPsurpopglyraamndpar9ic0e-d. aPyrsourpaptleydofpdrriucginsgcoivsenreodtbayvbaoiltahbtlheeu$n9der tPhreogPrarmogarnadm$2f4oRr eptraeilpParocgkraagmeadredprurogrsa.teFdobrapsreidcoinngthpeo$li9cPiersogrrealmatpinrigcet,obuptrwepillancoktaged derxucegesd($s2u4c.hPariscetsufboersq,uvainatlistieosrgbroeattteler sth),asneae9S0e-dcatyiosunp5pl.y of drugs covered by the $24

4. URentdaeil rPrtohgeraPmroagrerapmrortahterdoubagshedWoanltmhear$t24MPariol gSrearmvipcreic,e$. 1P0roisrattheed pprricicinegfios nromt aaviladilaebllievery oufndae9r t0h-edParyogsurapmpflyoropfrecpearctkaaignegdednruegrsic. Fdorrupgrsicaintgcpoomlicmiesornellaytipnrgetsocprribepeadckdaogseadgderusg(s",$10 MseaeiSl eScetriovnic6e. Program"). $24 is the price for mail delivery of certain women's health

5. aUnnddecretrhteaPinroogtrhamertchorovuegrheWd adlmruagrtsMataicl Soemrvmiceo,n$l1y0pisrtehsecprribiceedfodromsaaigl deesli(v"e$ry24ofMa ail S9e0r-vdaicyesuPprpolygoraf mce"r)ta. iNn ogetnaelrlidcrduruggsscaotvceormemdobnylytphrees$c1r0ibeRdedtoasilaPgerso(g"r$a10mMaariel Sceorvviceered bPyrotghream$"1)0. $M24aiilsStheervpirciceePforor mgraailmde;lnivoertyaollfdcerurtgaisncwoovmeeren'ds hbeyaltthhean$d2c4erRtaeitnaoilthPerrogram acroevecroedvedrreugdsbayt ctohmem$2o4nlyMpareilscSreibrevdicdeoPsargoegsr(a$2m4.MWaaillmSearvritceMPariol gSrearmv"i)c.eNcootvaellrdsrubgosth initial fills and refills. Delivery of covered drugs is available only through Walmart

Mail Service and is not available at Walmart and Neighborhood Market retail pharmacies. Delivery under the Program through Walmart Mail Service is limited tcooUve.Sre.dadbydtrheess$e10s RbeytaFiilrPsrto-gCralamssarMe acoil;veerxepdebdyitheed$d10elMivaeilrSyeirsviaclesoPraovgarialmab; lneoftoarll an addrduigtsiocnovael rcehdabrygteh.eS$o2m4 eRehteaial lPtrhogprlaamnsardeocnovoetrecdovbyerthWe a$2lm4 aMratilMSearivl iSceerPvriocgeraomr.9S0e-e dMayailsSueprpvilcieesDorfugthLeistPfroor garliastmo'fsddrurugsgcso. Pverricedesbyfothreq$u1a0nMtiatiileSsegrvrieceatPerorgtrhaamnaand90$2-4day sMupapil lSyeorvficderPurgosgrcaomv.eWreadlmbayrttMheail$S1e0rvMiceaicl oSveerrvsibcoethPrinoitgiarlafmillsaanddrtehfeills$. 2D4elMiveariyl Soef rvice PcroovgereadmdraurgespisraovraailtaebdleboanslyetdhroonugthheW$al1m0aartnMda$il2S4erPvricoegarnadmispnroitcaev,arileabspleeacttWivaelmlya. rt ParnicdeNsefigohrbqourhaonotditiMesarlkeestsrtehtaailnpaha9rm0-adciaeys.sDupelpivleyryaruendneortthperoPrroagteradmutnhdroeurgehitWhaelmr tahrte $M10aiMl SaerilvSiceerivs ilcimeitPerdotgorUa.mS. aodrdtrehsese$s2b4y FMirastil-CSlearsvs iMceailP; eroxpgerdaimted. Pdreolivreartyeids aplsroicing is not aavvaaiillaabblleefuornadneardtdhiteioPnraol cghraarmge.foSrompreehpeaacltkhapglaends ddorungost.cFooverrpWriaclimnagrtpMolaiicl iSeesrvriecleaotirng to p9r0e-pdaacyksaugppeldiesd. rPurgicse,ssfeoer qSueacnttiiotiens5g.reater than a 90-day supply of drugs covered by the

5. P$r1e0pMaacikl SaegrevdicedPruroggsraamreacnodvtheere$d24uMndaiel rSetrhveicPe rPoroggrraamm oarnelyprionrattheedubnasitedsioznesthsep$e1c0ified oanndth$e24RPertoagirlaDmruprgicLei,srte.sPpreectpivaeclky.agPreicdeds frourgqsuaarnetitdieisspleesns stheadnbaa9s0e-ddaoynsutphpelyqaureanntoitties pprreosrcatreibdeudndaenrdeiuthneitr tshizee$s10inMsatiol ScekrvaitcethPerodgirsapmenorsitnhge $p2h4aMrmaial Sceyr.vUicneiPtrsoizgerasmn.ot sPpreocraiftieeddporincinthgeisRnoettavilaDilarbuleguLnidsetratrheenPorotgcraomvefroerdpruenpadcekragthededPrruoggs.rFaomr.pMricuinltgiupnoitlicpieusrrcehlaatsinegstaorperecphaacrkgaegdedadtraugpse, sreuenSietcptiroicne6,. based on the price per unit size

6. dPisreppeancskeagde, dundrleugsss aortehceorvweriseed uspndeecriftiheedP. rPorgerapmacoknalygeindthderuungist sdiziseps espnesceifdieidnounntihtesizes nqaRqsvoupueaateatinclansaiitptflbiiiDteteliieedcresuisoufgpinnoerLedtfdihssettceohrraRnientbehdetdthedaMreiualPanDgRirldorSeauugetrgnrearviLatiliaimcssDvetizaoerfDiousrlraMgirunbgpaLlseirtLilsoeiSsitcnptek.marsvPacpaitrckeyeteahpcbgDeaifeecrdiukedipasgdpgrdLieeurcinsdunetsgdidiatnsrrguh.segiipzngsheohaastrer.ecmrPo,darveicosevpyrr.eeeadnnUtseuneidfnidtdepsbeiqzrareuistcseihivdnneaogolteninsthtneot

6. PPrriocgersamof. cMeurltai-iunnidtrpuugrcshcaosevsearreedchbayrgtehdeaPtraopgerraumnitmpraicyeb, beahseigdhoenrthinesporimceepsetrautneits, as nsoizteeddisopenntsheed,RunelteassiloDthreurgwLisiests.pecified. Prepackaged drugs dispensed in unit sizes not

7. PasevrpqaoeuigcliavirfabailelemedntoapnqsruitlcoahnienntgRgiteiaemtssaaioslyfuDtpbrhupeegldileLirmisustgiftaraenorddemMtaovsaauisillceaShbleelremcviitncaemnspuDaefrncauiucfgifteLaudicsruttenumrirstaesyarirzbseeeosi.pfnrPaisrcotecordoacvthkeeigdarhepterdrti,chdeienvrgeudnigissifnpaonetdnsiisng pahvaairlambalecuyn. der the Program for prepackaged drugs.

78.. YhtPoehruaeicltRemhseatopayflilacpDenarr.ytuPaglireneLsdisssrctuoragrinbsdmecMorovpareieelreSrtdmehrbavisynicsteithoheDnerPumPrgoragLoyrigsabtmr.eammreapyqrbuiecirehe,idgdhteeopr cienhnsadonimngegesoatan3tet0sh-,edasatneyorptmeredssoocnfriypotuiorn 8. tPoroag9r0am-dparyicpinrgemscaryipbetiolimn.itCedetrotasienlepcltamnsa,niunfcaclutudrienrgs ogfoavceorvnemreedndtr-ufguannddeids apvraoilagbrlaemass,

mloanygnasostucpopvlieesrfaro9m0s-udcahymsuanpupflayc.turers are in stock at the dispensing pharmacy.

99.. FYoorupmuarycphaaysleesssmoradmeoraettWhaanltmhearPtroRgertaamilpPrhicaer,mdeapceinedsi,npgroenstchreiptteiromnssomf yuosutrihneitailathlly be fpillaend. iPnrepsecrisboenr ,paenrmdisrseiofinllms mayubsetrbeqeupiriecdketodcuhpanignesato30re-d. aTyhperreescarripetinoon tsouabs9t0it-duatyions. Ppurrecschraipsteiosnm. Caderetatihnrpolaungs,hinWcluadlmingargtoMvearnilmSeenrtv-ifcuendmedayprboegroamrdse, mready naottWcoavlmeraart Retail P9h0a-rdmayascuipepsl,yb. y phone or through .

1100..TFhoerspeurPcrhoagsersammaDdeeattaWilsalamrearstuRbetjeaicl tPhtoarmchaacinegs,eprweistchrioputitonasdmvaunstcienitniaolltyicbee.fCillehdaninges to tpheersseonP, raondgrraemfillsDmeutsatilbsempiacykebdeupminadsteoroen. lyThinerwe rairteinngo.substitutions. Purchases made

through Walmart Mail Service may be ordered at Walmart Retail Pharmacies, by phone or

through .

11. These Program Details are subject to change without advance notice. Changes to these

Program Details may be made only in writing.

AcceAsscicbeilsistyib&ilitNyo&n-NDoisnc-rDimisicnraitmioination WalmWaartlmisacrot mis mcoitmtemditotemd atokinmgaiktisnhgeiatslthcearltehcare servisceersvaiccecsesascicbelesstioblaelltsoeaelklisnegetkoinugsetothuesemtahnedm and provpidreosvaiduexsiliaaurxyilaiaidrsyaaniddssaenrvdicsesr,vinccelsu,dinincgluldainnggulaagneguage assisatasnsicsetasnecrevisceersv, itcoeps,atoiepnatstiaetnntsoactonsot. cWoasltm. Waratlmart will nwoitlldniosctrdimiscinraimteinoantethoenbtahseisboafsrisacoef,rcaocleo,rc, olor, nationnaatlioonriaglion,risgeixn,, asgeex,, aogred,isoarbdiliistyabainlidtywainlldnowtill not retalriaettealaiagtaeinasgtaainnsytoanneywohnoe rwahisoesraaisceosmapcloaimntpolafint of discrdimiscinraimtioinna. tion.

ComCpolaminptslaoinrtGs roier vGarniceevsances luceoYiatniramoctayirilccuaooepce.tcauloeYsaaalrsmcosilaniolcbuWoptfeihcolalosaiaatalrsrlsiyvmmlnioibeWntoaaihiltrortliaahttirdalayvmepciitesnocehraciiteratrrgahitsridhamemsgpittisrebihranctiieiacogaralivryithtmrgma,iytaornviiaiotnnscieosce,raeviyoptrdac,rianlonieoevsinscgnacicsees,aecrieopirencmrdnlrteoeineingncnarsgacesaooreetndrirrtoinennsrgor to ingitriaietveance by contacting either (1) the office of a forWmaallmacacrte'sssVibiiclietyPorersdidisecnritm, UinSatEiothnicgsri&evCanocmepbliyance cont(a1c-t8i0ng0-eWithMe-rE(t1h) itcheoroefftihciecso@f Wwaallmmaarrtt'.scoVmic)eor (2) the PresiOdeffnitc,eUoSfECtihviiclsR&igChtosm, Up.lSia.nDcep(t1-. 8H0e0a-ltWhM&-HEtuhmican or etSheicrsv@icewsa(lm1-8ar0t0.c-o3m6)8o-1r0(129)othreOOCfRfiCceomofpClaivnitl@). Rights, U.S. Dept. Health & Human Services (1-800368-1019 or OCRComplaint@).

English Translation: Interpreter Services are available at no cost. Please visit your local Walmart for assistance.

Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Higher dosages cost more. Prices for some drugs covered by the Prescription Program may be higher in some states, including but not necessarily limited to, CA, HI, MN, MT, PA, TN, WI, and WY. Prices may also vary in some states. For important information regarding Walmart's Patient accessibility program, including the availability of language interpretive services, please see the last page.

Prepackaged drugs are covered only in unit sizes specified on Drug List (back page)other restrictions may apply. See P?ro2g0ra1m8 WDaeltmailasrot rAypooulrloW, LaLlmCa|rPt aPghear3moafc3ist for details.

?2017AWrt Rale-vMisaerdt 1S1/t0o9r/e2s0,1I8nc11.:|14PAaMge 5 of 5

Revised 12/15/2E0f1f7ective 11/28/2018

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