TL 30 EAST 76TH STREET 6TH FLOOR NEW YORK, NY 10021 Prescriber Signature X THIS PRESCRIPTION WILL BE FILLED GENERICA REFILLS SCRIBER WRITES 'ciaW IN THE BOX BELOW OMMBGW 35 Dispense As Written Apen•sitml0 PIKITECTION • '"T N13ItETa.4140, 59 EFTA01172016