Exhibit C.xlsx

Exhibit C is a pharmaceutical product submission template prepared for the Minnesota Medication Assistance to Children and Adults Program (MMCAP) Infuse Responder initiative, administered through the State of Minnesota's health department located at 112 Administration Building, 50 Sherburne Avenue, Saint Paul, MN 55155. The document serves as a standardized form for pharmaceutical vendors to submit additional proposed products for inclusion in the MMCAP formulary under indirect sales channels. Vendors are required to provide comprehensive product information including NDC codes in 5-4-2 format, SKU numbers, UPC codes, generic and trade descriptions, strength, dosage form, packaging details, and pricing data. The contract term referenced is July 1, 2022, through June 30, 2023, covering all trade classes with indirect sales arrangements.

Pricing submissions must include WAC (Wholesale Acquisition Cost) prices and bid prices calculated to two decimal points, with an administrative fee of three percent applied. The template requires vendors to specify bid types including fixed price (FP) or net pricing for 30, 60, and 90-day periods (NF30, NF60, NF90) or WAC-based pricing. This exhibit functions as part of a larger MMCAP procurement process, establishing standardized requirements for pharmaceutical product submissions and pricing structures to ensure consistent evaluation and administration of medication assistance programs across Minnesota's health system.