**Exhibit 4.12**

EXECUTION COPY 

**K-V PHARMACEUTICAL COMPANY**

**REGISTRATION RIGHTS AGREEMENT**

**November 17, 2010**

**TABLE OF CONTENTS**

 
      **Page** Section 1.  Definitions   1  Section 2.  Demand Registrations   4  Section 3.  Piggyback Registrations   6  Section 4.  Registration Procedures   7  Section 5.  Registration Expenses   11  Section 6.  Indemnification and Contribution   11  Section 7.  Underwritten Registrations   13  Section 8.  Current Public Information   14  Section 9.  Subsidiary Public Offering   14  Section 10.  General Provisions   14  
 
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**K-V PHARMACEUTICAL COMPANY**

**REGISTRATION RIGHTS AGREEMENT**

THIS REGISTRATION RIGHTS AGREEMENT (this “Agreement”) is made as of November 17, 2010, among K-V Pharmaceutical Company, a Delaware corporation (the “Company”), U.S.Healthcare I, L.L.C. (“U.S. Healthcare I”) and U.S. Healthcare II, L.L.C., (“U.S. Healthcare II”, and together with U.S. Healthcare I and their registered assigns collectively referred to herein as the “USHInvestor”). Except as otherwise specified herein, all capitalized terms used in this Agreement are defined in Section 1. 

The Company and the USH Investor are parties to that certain Stock Warrant Purchase Agreement dated as of the date hereof (the “Purchase Agreement”), pursuant to which the USH Investorpurchased warrants to purchase shares of Class A Common Stock from the Company (the “Warrants”). In order to induce the USH Investor to enter into the Purchase Agreement, the Company has agreed to provide the registrationrights set forth in this Agreement. The execution and delivery of this Agreement is a condition to the consummation of the transactions under the Purchase Agreement. 

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties to thisAgreement hereby agree as follows: 

Section 1. Definitions. Unless otherwise set forth below or elsewhere in thisAgreement, other capitalized terms contained herein have the meanings set forth in the Purchase Agreement. 

“Affiliate” of any Person means any other Person controlled by, controlling or under common control with such Person;provided that the Company and its Subsidiaries shall not be deemed to be Affiliates of any holder of Registrable Securities. As used in this definition, “control” (including, with its correlative meanings, “controlling,”“controlled by” and “under common control with”) shall mean possession, directly or indirectly, of power to direct or cause the direction of management or policies (whether through ownership of securities, by contract orotherwise). With respect to any Person who is an individual, “Affiliates” shall also include, without limitation, any member of such individual’s Family Group. 

“Agreement” has the meaning set forth in the recitals. 

“Capital Stock” means (i) with respect to any Person that is a corporation, any and all shares, interests orequivalents in capital stock of such corporation (whether voting or nonvoting and whether common or preferred) and (ii) with respect to any Person that is not a corporation, individual or governmental entity, any and all partnership,membership, limited liability company or other equity interests of such Person that confer on the holder thereof the right to receive a share of the profits and losses of, or the distribution of assets of, the issuing Person, including in each caseany and all warrants (other than the Warrants), rights (including conversion and exchange rights) and options to purchase any of the foregoing. 

“Closing” has the meaning set forth in the Purchase Agreement. 

“Common Stock” means the Company’s Class A common stock, par value $0.01 per share. 

“Company” has the meaning set forth in the preamble. 

“Demand Registrations” has the meaning set forth in Section 2(a). 

“Exchange Act” means the Securities Exchange Act of 1934, as amended from time to time, or any successor federal lawthen in force, together with all rules and regulations promulgated thereunder. 

“Family Group” means, withrespect to a Person who is an individual, (i) such individual’s spouse and descendants (whether natural or adopted) (collectively, for purposes of this definition, “relatives”), (ii) such individual’s executor orpersonal representative, (iii) any trust, the trustee of which is such individual or such individual’s executor or personal representative and which at all times is and remains solely for the benefit of such individual and/or suchindividual’s relatives, (iv) any corporation, limited partnership, limited liability company or other tax flow-through entity the governing instruments of which provide that such individual or such individual’s executor or personalrepresentative shall have the exclusive, nontransferable power to direct the management and policies of such entity and of which the sole owners of stock, partnership interests, membership interests or any other equity interests are limited to suchindividual, such individual’s relatives and/or the trusts described in clause (iii) above, and (v) any retirement plan for such individual or such individual’s relatives. 

“FINRA” means the Financial Industry Regulatory Authority. 

“Indemnified Parties” has the meaning set forth in Section 6(a). 

“Issuer Free-Writing Prospectus” means an issuer free-writing prospectus as defined in Rule 433 under the SecuritiesAct. 

“Long-Form Registrations” has the meaning set forth in Section 2(a). 

“Person” means an individual, a partnership, a corporation, a limited liability company, an association, a joint stockcompany, a trust, a joint venture, an unincorporated organization and a governmental entity or any department, agency or political subdivision thereof. 

“Piggyback Registrations” has the meaning set forth in Section 3(a). 

“Public Offering” means any sale or distribution by the Company and/or holders of Registrable Securities to the public of Common Stock of the Company pursuant to an offering registeredunder the Securities Act. 

“Purchase Agreement” has the meaning set forth in the recitals. 

 
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“Registrable Securities” means (i) any Common Stock issued pursuant tothe exercise of the Warrants or distributed (directly or indirectly) to the USH Investor or any of their respective Affiliates, and (ii) any Capital Stock of the Company or any Subsidiary of the Company issued or issuable with respect to thesecurities referred to in clause (i) above by way of dividend, distribution, split or combination of securities, or any recapitalization, merger, consolidation or other reorganization. As to any particular Registrable Securities, suchsecurities shall cease to be Registrable Securities when they have been (a) sold or distributed pursuant to a Public Offering, (b) disposed of pursuant to Rule 144 or which may be disposed of pursuant to Rule 144 without volume or timingrestrictions, or (c) repurchased by the Company or a Subsidiary of the Company. For purposes of this Agreement, a Person shall be deemed to be a holder of Registrable Securities, and the Registrable Securities shall be deemed to be inexistence, whenever such Person has the right to acquire, directly or indirectly, such Registrable Securities (upon conversion or exercise in connection with a transfer of securities or otherwise, but disregarding any restrictions or limitationsupon the exercise of such right), whether or not such acquisition has actually been effected, and such Person shall be entitled to exercise the rights of a holder of Registrable Securities hereunder. 

“Registration Expenses” has the meaning set forth in Section 5(a). 

“Rule 144”, “Rule 158”, “Rule 405”, “Rule 415” and “Rule462” mean, in each case, such rule promulgated under the Securities Act (or any successor provision) by the Securities and Exchange Commission, as the same shall be amended from time to time, or any successor rule then in force. 

“Securities Act” means the Securities Act of 1933, as amended from time to time, or any successor federal law then inforce, together with all rules and regulations promulgated thereunder. 

“Shelf Registration” has the meaningset forth in Section 2(c). 

“Short-Form Registrations” has the meaning set forth inSection 2(a). 

“Subsidiary” means, with respect to the Company, any corporation, limitedliability company, partnership, association or other business entity of which (i) if a corporation, a majority of the total voting power of shares of stock entitled (without regard to the occurrence of any contingency) to vote in the electionof directors, managers or trustees thereof is at the time owned or controlled, directly or indirectly, by the Company or one or more of the other Subsidiaries of the Company or a combination thereof, or (ii) if a limited liability company,partnership, association or other business entity, a majority of the limited liability company, partnership or other similar ownership interest thereof is at the time owned or controlled, directly or indirectly, by the Company or one or moreSubsidiaries of the Company or a combination thereof. For purposes hereof, a Person or Persons shall be deemed to have a majority ownership interest in a limited liability company, partnership, association or other business entity if such Person orPersons shall be allocated a majority of limited liability company, partnership, association or other business entity gains or losses or shall be or control the managing director or general partner of such limited liability company, partnership,association or other business entity. 

 
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“Suspension Period” shall mean any period in which a registration statementcovering Registrable Securities is subject to the events described in Section 4(a)(vi). 

“Violation” hasthe meaning set forth in Section 6(a). 

“Warrants” has the meaning set forth in the recitals.

“WKSI” means a “well-known seasoned issuer” as defined under Rule 405. 

“USH Investor” has the meaning set forth in the recitals. 

Section 2. Demand Registrations. 

(a) Requests for Registration. Subject to the terms and conditions of this Agreement, at any time, the holders of 25% or more of the Registrable Securities may request registration under theSecurities Act of all or any portion of their Registrable Securities on Form S-1 or any similar long-form registration (“Long-Form Registrations”), and the holders of 5% or more of the Registrable Securities may request registrationunder the Securities Act of all or any portion of their Registrable Securities on Form S-3 (including pursuant to Rule 415) or any similar short-form registration (“Short-Form Registrations”) if available. All registrationsrequested pursuant to this Section 2(a) are referred to herein as “Demand Registrations”. Each request for a Demand Registration shall specify the approximate number of Registrable Securities requested to be registeredand the intended method of distribution. Within ten days after the filing of the registration statement relating to the Demand Registration, the Company shall give written notice of the Demand Registration to all other holders of RegistrableSecurities and, subject to the terms of Section 2(d), shall include in such Demand Registration (and in all related registrations and qualifications under state blue sky laws and in any related underwriting) all Registrable Securitieswith respect to which the Company has received written requests for inclusion therein within 15 days after the receipt of the Company’s notice. 

(b) Long-Form Registrations. The holders of Registrable Securities shall be entitled to request up to three Long-Form Registrations in which the Company shall pay all Registration Expenses (asdefined in Section 5(a)), whether or not any such registration is consummated. 

(c) Short-FormRegistrations. In addition to the Long-Form Registrations provided pursuant to Section 2(b), the holders of Registrable Securities shall be entitled to request an unlimited number of Short-Form Registrations in which the Companyshall pay all Registration Expenses. Demand Registrations shall be Short-Form Registrations whenever the Company is permitted to use any applicable short form and if the managing underwriters (if any) agree to the use of a Short-Form Registration.The Company shall make Short-Form Registrations available for the sale of Registrable Securities. If the holders of the Registrable Securities request that a Short-Form Registration be filed pursuant to Rule 415 (a “ShelfRegistration”), the Company shall use best efforts to cause the Shelf Registration to be declared effective under the Securities Act as soon as practicable after filing, and once effective, the Company shall use best efforts to cause theShelf Registration to remain effective for a period ending on the earlier of (i) the date on which all Registrable Securities included in such registration have been sold or distributed pursuant to the Shelf Registration or (ii) the dateas of 

 
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which all of the Registrable Securities included in such registration are able to be sold within a 90-day period in compliance with Rule 144. If for any reason the Company ceases to be a WKSI orbecomes ineligible to utilize Form S-3, the Company shall prepare and file with the Securities and Exchange Commission a registration statement or registration statements on such form that is available for the sale of Registrable Securities.

(d) Priority on Demand Registrations. The Company shall not include in any Demand Registration any securities whichare not Registrable Securities without the prior written consent of a majority of the holders of the Registrable Securities. If a Demand Registration is an underwritten offering and the managing underwriters advise the Company in writing that intheir opinion the number of Registrable Securities and, if permitted hereunder, other securities requested to be included in such offering exceeds the number of Registrable Securities and other securities, if any, which can be sold therein withoutadversely affecting the marketability, proposed offering price, timing or method of distribution of the offering, the Company shall include in such registration prior to the inclusion of any securities which are not Registrable Securities the numberof Registrable Securities requested to be included which, in the opinion of such underwriters, can be sold, without any such adverse effect, pro rata among the respective holders thereof on the basis of the amount of Registrable Securities owned byeach such holder. 

(e) Selection of Underwriters. The holders of a majority of the Registrable Securities included inan underwritten offering shall have the right to select the investment banker(s) and manager(s) to administer the offering and the Company shall pay all reasonable expenses in connection therewith. 

(f) Other Registration Rights. The parties to this Agreement acknowledge that the Company is party to a Settlement Agreement,dated as of November 15, 2010 (the “Settlement Agreement”), by among the Company, The Office of Inspector General of the United States Department of Health and Human Services, Sarah Weltscheff and Marc Hermelin. Pursuant to theSettlement Agreement, the Company has agreed, among other things, to register under the Securities Act certain shares of the Class A Common Stock and Class B Common Stock of the Company beneficially owned by Ms. Weltscheff andMr. Hermelin. The parties acknowledge and agree that the Company shall be entitled to register such shares pursuant to a registration statement filed under the Securities Act and take such other actions necessary to fulfill its obligationsunder the Settlement Agreement. During any period in which any amount remains unpaid under that certain Credit and Guaranty Agreement, dated as of November 17, 2010, by and among the Company, as borrower and certain of its subsidiaries, asguarantors, the lenders party thereto from time to time and U.S. Healthcare I, as administrative agent and collateral agent (the “Credit Agreement”), the Company shall not grant to any Persons the right to request the Company or anySubsidiary to register any Class A Common Stock or Class B Common Stock of the Company, or any securities convertible or exchangeable into or exercisable for such securities, without the prior written consent of a majority of the holders of theRegistrable Securities, except in respect of the Settlement Agreement. Following the repayment of all amounts under the Credit Agreement, the Company shall not grant to any Persons the right to request the Company or any Subsidiary to register anyClass A Common Stock or Class B Common Stock of the Company, or any securities convertible or exchangeable into or exercisable for such securities, that are superior to or materially interfere with the intended plan of distribution of theholders of the Registrable Securities, except in respect of the 

 
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Settlement Agreement. Furthermore, the Company shall cause the Registrable Securities to be registered under the Securities Act no later than the date of registration of the shares of theClass A Common Stock and Class B Common Stock of the Company to be registered in accordance with the Settlement Agreement. 

Section 3. Piggyback Registrations. 

(a) Right to Piggyback. Whenever the Company proposes to register any of its securities under the Securities Act (other than (i) pursuant to a Demand Registration or (ii) in connectionwith registrations on Form S-4 or S-8 promulgated by the Securities and Exchange Commission or any successor or similar forms) and the registration form to be used may be used for the registration of Registrable Securities (a “PiggybackRegistration”), the Company shall give prompt written notice to all holders of Registrable Securities of its intention to effect such Piggyback Registration and, subject to the terms of Section 3(c) and Section 3(d).shall include in such Piggyback Registration (and in all related registrations or qualifications under blue sky laws and in any related underwriting) all Registrable Securities with respect to which the Company has received written requests forinclusion therein within 20 days after delivery of the Company’s notice. 

(b) Piggyback Expenses. The RegistrationExpenses of the holders of Registrable Securities shall be paid by the Company in all Piggyback Registrations, whether or not any such registration became effective. 

(c) Priority on Primary Registrations. If a Piggyback Registration is an underwritten primary registration on behalf of the Company, and the managing underwriters advise the Company in writing thatin their opinion the number of securities requested to be included in such registration exceeds the number which can be sold in such offering without adversely affecting the marketability, proposed offering price, timing or method of distribution ofthe offering, the Company shall include in such registration (i) first, the securities the Company proposes to sell, (ii) second, the Registrable Securities requested to be included in such registration which, in the opinion of theunderwriters, can be sold without any such adverse effect, pro rata among the holders of such Registrable Securities on the basis of the number of shares owned by each such holder, and (iii) third, other securities requested to be included insuch registration which, in the opinion of the underwriters, can be sold without any such adverse effect. 

(d) Priority onSecondary Registrations. If a Piggyback Registration is an underwritten secondary registration on behalf of holders of the Company’s securities, and the managing underwriters advise the Company in writing that in their opinion the number ofsecurities requested to be included in such registration exceeds the number which can be sold in such offering without adversely affecting the marketability, proposed offering price, timing or method of distribution of the offering, the Companyshall include in such registration (i) first, the securities requested to be included therein by the holders requesting such registration and the Registrable Securities requested to be included in such registration which, in the opinion of theunderwriters, can be sold without any such adverse effect, pro rata among the holders of such securities on the basis of the number of securities owned by each such holder, and (ii) second, securities proposed to be included by the Company, and(iii) third, other securities requested to be included in such registration which, in the opinion of the underwriters, can be sold without any such adverse effect. 

 
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Section 4. Registration Procedures. 

(a) Whenever the holders of Registrable Securities have requested that any Registrable Securities be registered pursuant to thisAgreement, the Company shall effect the registration and the sale of such Registrable Securities in accordance with the intended method of disposition thereof, and pursuant thereto the Company shall as promptly as reasonably practicable: 

(i) in accordance with the Securities Act and all applicable rules and regulations promulgated thereunder, prepare andfile with the Securities and Exchange Commission a registration statement, and all amendments and supplements thereto and related prospectuses, with respect to such Registrable Securities and use best efforts to cause such registration statement tobecome effective (provided that before filing a registration statement or prospectus or any amendments or supplements thereto, the Company shall furnish to the counsel selected by the holders of the Registrable Securities covered by suchregistration statement copies of all such documents proposed to be filed); 

(ii) notify each holder ofRegistrable Securities of (A) the issuance by the Securities and Exchange Commission of any stop order suspending the effectiveness of any registration statement or the initiation of any proceedings for that purpose, (B) the receipt by theCompany or its counsel of any notification with respect to the suspension of the qualification of the Registrable Securities for sale in any jurisdiction or the initiation or threatening of any proceeding for such purpose, and (C) theeffectiveness of each registration statement filed hereunder; 

(iii) prepare and file with the Securities andExchange Commission such amendments and supplements to such registration statement and the prospectus used in connection therewith as may be necessary to keep such registration statement effective for a period ending the earlier of (i) when allof the securities covered by such registration statement have been disposed of in accordance with the intended methods of distribution by the sellers thereof set forth in such registration statement, and (ii) such date as when all RegistrableSecurities covered by the registration statement have been disposed of or may be disposed of without volume or timing restrictions pursuant to Rule 144 (but not in any event before the expiration of any longer period required under the SecuritiesAct or, if such registration statement relates to an underwritten Public Offering, such longer period as in the opinion of counsel for the underwriters a prospectus is required by law to be delivered in connection with sale of Registrable Securitiesby an underwriter or dealer) and comply with the provisions of the Securities Act with respect to the disposition of all securities covered by such registration statement during such period in accordance with the intended methods of disposition bythe sellers thereof set forth in such registration statement; 

 
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(iv) furnish to each seller of Registrable Securities thereunder such numberof copies of such registration statement, each amendment and supplement thereto, the prospectus included in such registration statement (including each preliminary prospectus), each Issuer Free-Writing Prospectus and such other documents as suchseller may reasonably request in order to facilitate the disposition of the Registrable Securities owned by such seller; 

(v) register or qualify such Registrable Securities under such other securities or blue sky laws of such jurisdictions as any seller reasonably requests and do any and all other acts and things which maybe reasonably necessary or advisable to enable such seller to consummate the disposition in such jurisdictions of the Registrable Securities owned by such seller, except that the Company shall not for any such purpose be required to (i) qualifygenerally to do business in any jurisdiction where it is not then so qualified, (ii) subject itself to taxation in any such jurisdiction where it is not then so subject; 

(vi) notify each seller of such Registrable Securities (A) promptly after it receives notice thereof, of the date andtime when such registration statement and each post-effective amendment thereto has become effective or a prospectus or supplement to any prospectus relating to a registration statement has been filed and when any registration or qualification hasbecome effective under a state securities or blue sky law or any exemption thereunder has been obtained, (B) promptly after receipt thereof, of any request by the Securities and Exchange Commission for the amendment or supplementing of suchregistration statement or prospectus or for additional information, and (C) at any time when a prospectus relating thereto is required to be delivered under the Securities Act, of the happening of any event as a result of which the prospectusincluded in such registration statement contains an untrue statement of a material fact or omits any fact necessary to make the statements therein not misleading, and, at the request of any such seller, the Company shall prepare a supplement oramendment to such prospectus so that, as thereafter delivered to the purchasers of such Registrable Securities, such prospectus shall not contain an untrue statement of a material fact or omit to state any fact necessary to make the statementstherein not misleading; 

(vii) use best efforts to cause all such Registrable Securities to be listed on eachsecurities exchange on which similar securities issued by the Company are then listed and, if not so listed, to be listed on a securities exchange and, if not then listed on NYSE, to use its best efforts to arrange for at least two market markers toregister as such with respect to such Registrable Securities with FINRA; 

(viii) provide a transfer agent andregistrar for all such Registrable Securities not later than the effective date of such registration statement; 

(ix) enter into and perform such customary agreements (including underwriting agreements in customary form) and take allsuch other actions as the holders of the Registrable Securities being sold or the underwriters, if any, reasonably request in order to expedite or facilitate the disposition of such Registrable Securities (including, without limitation, effecting astock split, combination of shares, recapitalization or reorganization); 

 
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(x) subject to execution of customary confidentiality arrangements, makeavailable for inspection by any seller of Registrable Securities, any underwriter participating in any disposition pursuant to such registration statement and any attorney, accountant or other agent retained by any such seller or underwriter, allfinancial and other records, pertinent corporate and business documents and properties of the Company as shall be necessary to enable them to exercise their due diligence responsibility, and cause the Company’s officers, directors, employees,agents, representatives and independent accountants to supply all information reasonably requested by any such seller, underwriter, attorney, accountant or agent in connection with such registration statement; 

(xi) take all reasonable actions to ensure that any Issuer Free-Writing Prospectus utilized in connection with any DemandRegistration or Piggyback Registration hereunder complies in all material respects with the Securities Act, is filed in accordance with the Securities Act to the extent required thereby, is retained in accordance with the Securities Act to theextent required thereby and, when taken together with the related prospectus, shall not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements therein, in light of the circumstances underwhich they were made, not misleading; 

(xii) otherwise comply with all applicable rules and regulations of theSecurities and Exchange Commission, and make available to its security holders, as soon as reasonably practicable, an earning statement covering the period of at least twelve months beginning with the first day of the Company’s first fullcalendar quarter after the effective date of the registration statement, which earnings statement shall satisfy the provisions of Section 11(a) of the Securities Act and Rule 158. 

(xiii) permit any holder of Registrable Securities which holder, in its sole and exclusive judgment, might be deemed to bean underwriter or a controlling person of the Company, to participate in the preparation of such registration or comparable statement and to allow such holder to provide language for insertion therein, in form and substance satisfactory to theCompany, which in the judgment of such holder and its counsel should be included; 

(xiv) in the event of theissuance of any stop order suspending the effectiveness of a registration statement, or the issuance of any order suspending or preventing the use of any related prospectus or suspending the qualification of any Common Stock included in suchregistration statement for sale in any jurisdiction, use best efforts to promptly to obtain the withdrawal of such order; 

(xv) cause such Registrable Securities covered by such registration statement to be registered with or approved by such other governmental agencies or authorities as may be necessary to enable the sellersthereof to consummate the disposition of such Registrable Securities; 

 
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(xvi) cooperate with the holders of Registrable Securities covered by theregistration statement and the managing underwriter or agent, if any, to facilitate the timely preparation and delivery of certificates (not bearing any restrictive legends) representing securities to be sold under the registration statement andenable such securities to be in such denominations and registered in such names as the managing underwriter, or agent, if any, or such holders may request; 

(xvii) cooperate with each holder of Registrable Securities covered by the registration statement and each underwriter or agent participating in the disposition of such Registrable Securities and theirrespective counsel in connection with any filings required to be made with FINRA; 

(xviii) in connection withany underwritten offering, make available the executive officers of the Company to participate with the holders of Registrable Securities and any underwriters in any “road shows” or other selling efforts that may be reasonably requested bythe holders in connection with the methods of distribution for the Registrable Securities; 

(xix) in connectionwith any underwritten offering, use best efforts to obtain one or more cold comfort letters from the Company’s independent public accountants in customary form and covering such matters of the type customarily covered by cold comfort letters;and 

(xx) in connection with any underwritten offering, use best efforts to provide a legal opinion of theCompany’s outside counsel, dated the effective date of such registration statement. 

(b) The Company shall not undertakeany voluntary act intended to cause a Violation or result in delay or suspension under Section 4(a)(vi). During any Suspension Period, and as may be extended hereunder, the Company shall correct or update any disclosure causing theCompany to provide notice of the Suspension Period and to file and cause to become effective or terminate the suspension of use or effectiveness, as the case may be, the subject registration statement. In the event that the Company shall exerciseits right to delay or suspend the filing or effectiveness of a registration hereunder, the applicable time period during which the registration statement is to remain effective shall be extended by a period of time equal to the duration of theSuspension Period. The Company may extend the Suspension Period for an additional consecutive 60 days with the consent of the holders of a majority of the Registrable Securities registered under the applicable registration statement, which consentshall not be unreasonably withheld. If so directed by the Company, all holders of Registrable Securities registering shares under such registration statement shall (i) not offer to sell any Registrable Securities pursuant to the registrationstatement during the period in which the delay or suspension is in effect after receiving notice of such delay or suspension and (ii) deliver to the Company (at the Company’s expense) all copies, other than permanent file copies then insuch holders’ possession, of the prospectus relating to such Registrable Securities current at the time of receipt of such notice. 

 
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Section 5. Registration Expenses. 

(a) The Company’s Obligation. All expenses incident to the Company’s performance of or compliance with this Agreement(including, without limitation, all registration, qualification and filing fees, fees and expenses of compliance with securities or blue sky laws, printing expenses, messenger and delivery expenses, fees and disbursements of custodians, and fees anddisbursements of counsel for the Company and all independent certified public accountants, underwriters and other Persons retained by the Company) (all such expenses being herein called “Registration Expenses”), shall be borne bythe Company. 

(b) Counsel Fees and Disbursements. In connection with each Demand Registration and each PiggybackRegistration, the Company shall reimburse the holders of Registrable Securities included in such registration for the reasonable fees and disbursements of one counsel chosen by a majority of the holders of the Registrable Securities requesting suchregistration for the purpose of rendering a legal opinion on behalf of such holder in connection with any underwritten Demand Registration or Piggyback Registration. 

Section 6. Indemnification and Contribution. 

(a) By theCompany. The Company shall indemnify and hold harmless, to the extent permitted by law, each holder of Registrable Securities, such holder’s officers, directors employees, agents and representatives, and each Person who controls such holder(within the meaning of the Securities Act) (the “Indemnified Parties”) against all losses, claims, actions, damages, liabilities and expenses (including with respect to actions or proceedings, whether commenced or threatened, andincluding attorney fees and expenses) caused by, resulting from, arising out of, based upon or related to any of the following statements, omissions or violations (each a “Violation”) by the Company: (i) any untrue or allegeduntrue statement of material fact contained in (A) any registration statement pursuant to which Registrable Securities are registered, any prospectus, preliminary prospectus or Issuer Free-Writing Prospectus included in any such registrationstatement, or any amendment thereof or supplement thereto or (B) any application or other document or communication (in this Section 6, collectively called an “application”) executed by or on behalf of the Companyor based upon written information furnished by or on behalf of the Company filed in any jurisdiction in order to qualify any Registrable Securities covered by such registration under the securities laws thereof, (ii) any omission or allegedomission of a material fact required to be stated therein or necessary to make the statements therein not misleading or (iii) any violation or alleged violation by the Company of the Securities Act or any other similar federal or statesecurities laws or any rule or regulation promulgated thereunder applicable to the Company and relating to action or inaction required of the Company in connection with any such registration, qualification or compliance; provided that the Companywill not be liable for losses arising out of written information provided by a holder for inclusion in the registration statement or sales of Registrable Securities made during a Suspension Period after notice has been given by the Company. Inaddition, the Company will reimburse such Indemnified Party for any reasonable legal or any other expenses incurred by them in connection with investigating or defending any such losses. 

(b) By Each Security Holder. In connection with any registration statement in which a holder of Registrable Securities isparticipating, each such holder shall furnish to the 

 
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Company in writing such information and affidavits as the Company reasonably requests for use in connection with any such registration statement or prospectus and, to the extent permitted by law,shall indemnify the Company, its officers, directors, employees, agents and representatives, and each Person who controls the Company (within the meaning of the Securities Act) against any losses, claims, damages, liabilities and expenses resultingfrom any untrue or alleged untrue statement of material fact contained in the registration statement, prospectus, preliminary prospectus or Issuer Free-Writing Prospectus or any amendment thereof or supplement thereto or any omission or allegedomission of a material fact required to be stated therein or necessary to make the statements therein not misleading, but only to the extent that such untrue statement or omission is contained in any information or affidavit so furnished in writingby such holder; provided that the obligation to indemnify shall be individual, not joint and several, for each holder and shall be limited to the net amount of proceeds received by such holder from the sale of securities pursuant to suchregistration statement. 

(c) Claim Procedure. Any Person entitled to indemnification hereunder shall (i) giveprompt written notice to the indemnifying party of any claim with respect to which it seeks indemnification (provided that the failure to give prompt notice shall impair any Person’s right to indemnification hereunder only to the extent suchfailure has prejudiced the indemnifying party) and (ii) unless in such indemnified party’s judgment a conflict of interest between such indemnified and indemnifying parties may exist with respect to such claim, permit such indemnifyingparty to assume the defense of such claim with counsel reasonably satisfactory to the indemnified party. If such defense is assumed, the indemnifying party shall not be subject to any liability for any settlement made by the indemnified partywithout its consent (but such consent shall not be unreasonably withheld, conditioned or delayed). An indemnifying party who is not entitled to, or elects not to, assume the defense of a claim shall not be obligated to pay the fees and expenses ofmore than one counsel for all parties indemnified by such indemnifying party with respect to such claim, unless in the judgment of any indemnified party a conflict of interest may exist between such indemnified party and any other of suchindemnified parties with respect to such claim. In such instance, the conflicted indemnified parties shall have a right to retain one separate counsel, chosen by the holders of the Registrable Securities included in the registration if such holdersare indemnified parties, at the expense of the indemnifying party. 

(d) Contribution. If the indemnification providedfor in this Section 6 is held by a court of competent jurisdiction to be unavailable to, or is insufficient to hold harmless, an indemnified party or is otherwise unenforceable with respect to any loss, claim, damage, liability or actionreferred to herein, then the indemnifying party shall contribute to the amounts paid or payable by such indemnified party as a result of such loss, claim, damage, liability or action in such proportion as is appropriate to reflect the relative faultof the indemnifying party on the one hand and of the indemnified party on the other hand in connection with the statements or omissions which resulted in such loss, claim, damage, liability or action as well as any other relevant equitableconsiderations. The relative fault of the indemnifying party and of the indemnified party shall be determined by reference to, among other things, whether the untrue or alleged untrue statement of a material fact or the omission to state a materialfact relates to information supplied by the indemnifying party or by the indemnified party and the parties’ relative intent, knowledge, access to information and opportunity to correct or prevent such statement or omission. The parties heretoagree that it would not be just or equitable if the contribution pursuant to this Section 6(d) were to be determined by pro rata allocation or by any 

 
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other method of allocation that does not take into account such equitable considerations. The amount paid or payable by an indemnified party as a result of the losses, claims, damages,liabilities or expenses referred to herein shall be deemed to include any legal or other expenses reasonably incurred by such indemnified party in connection with investigating or defending against any action or claim which is the subject hereof. Noperson guilty of fraudulent misrepresentation (within the meaning of Section 11(f) of the Securities Act) shall be entitled to contribution from any Person who is not guilty of such fraudulent misrepresentation. 

(e) Release. No indemnifying party shall, except with the consent of the indemnified party, consent to the entry of any judgmentor enter into any settlement that does not include as an unconditional term thereof giving by the claimant or plaintiff to such indemnified party of a release from all liability in respect to such claim or litigation. 

(f) Non-exclusive Remedy; Survival. The indemnification and contribution provided for under this Agreement shall be in addition toany other rights to indemnification or contribution that any indemnified party may have pursuant to law or contract and shall remain in full force and effect regardless of any investigation made by or on behalf of the indemnified party or anyofficer, director or controlling Person of such indemnified party and shall survive the transfer of Registrable Securities and the termination or expiration of this Agreement. 

Section 7. Underwritten Registrations; Suspended Distributions. 

(a)Participation. No Person may participate in any registration hereunder which is underwritten unless such Person (i) agrees to sell such Person’s securities on the basis provided in any underwriting arrangements approved by thePerson or Persons entitled hereunder to approve such arrangements (including, without limitation, pursuant to any over-allotment or “green shoe” option requested by the underwriters; provided that no holder of Registrable Securitiesshall be required to sell more than the number of Registrable Securities such holder has requested to include) and (ii) completes and executes all questionnaires, powers of attorney, indemnities, underwriting agreements and other documentsrequired under the terms of such underwriting arrangements; provided that no holder of Registrable Securities included in any underwritten registration shall be required to make any representations or warranties to the Company or theunderwriters (other than representations and warranties regarding such holder and such holder’s intended method of distribution) or to undertake any indemnification obligations to the Company or the underwriters with respect thereto that arematerially more burdensome than those provided in Section 6. 

(b) Suspended Distributions. Each Person thatis participating in any registration under this Agreement, upon receipt of any notice from the Company of the happening of any event giving rise to a Suspension Period, shall immediately discontinue the disposition of its Registrable Securitiespursuant to the registration statement until such Person’s receipt of the copies of a supplemented or amended prospectus as contemplated by Section 4(a)(vi). In the event the Company has given any such notice, the applicable timeperiod set forth in Section 4(a)(ii) during which a Registration Statement is to remain effective shall be extended by the number of days during the period from and including the date of the giving of such notice pursuant to thisSection 7(b) to and including the date when each seller of Registrable Securities covered by such registration statement shall have received the copies of the supplemented or amended prospectus contemplated bySection 4(a)(vi). 

 
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Section 8. Current Public Information. At all times after the Company has fileda registration statement with the Securities and Exchange Commission pursuant to the requirements of either the Securities Act or the Exchange Act, the Company shall file all reports required to be filed by it under the Securities Act and theExchange Act and shall take such further action as any holder or holders of Registrable Securities may reasonably request, all to the extent required to enable such holders to sell Registrable Securities pursuant to Rule 144. Upon request, theCompany shall deliver to any holder of Restricted Securities a written statement as to whether it has complied with such requirements. 

Section 9. Subsidiary Public Offering. If, after an initial Public Offering of the Capital Stock of one of its Subsidiaries, the Company distributes securities of such Subsidiary to its equityholders, then the rights and obligations of the Company pursuant to this Agreement shall apply, *mutatis mutandis*, to such Subsidiary, and the Company shall cause such Subsidiary to comply with such Subsidiary’s obligations under thisAgreement. 

Section 10. General Provisions. 

(a) Amendments and Waivers. Except as otherwise provided herein, the provisions of this Agreement may be amended, modified orwaived only with the prior written consent of the Company and a majority of the holders of the Registrable Securities. The failure or delay of any Person to enforce any of the provisions of this Agreement shall in no way be construed as a waiver ofsuch provisions and shall not affect the right of such Person thereafter to enforce each and every provision of this Agreement in accordance with its terms. A waiver or consent to or of any breach or default by any Person in the performance by thatPerson of his, her or its obligations under this Agreement shall not be deemed to be a consent or waiver to or of any other breach or default in the performance by that Person of the same or any other obligations of that Person under this Agreement.

(b) Remedies. The parties to this Agreement shall be entitled to enforce their rights under this Agreementspecifically (without posting a bond or other security), to recover damages caused by reason of any breach of any provision of this Agreement and to exercise all other rights existing in their favor. The parties hereto agree and acknowledge that abreach of this Agreement would cause irreparable harm and money damages would not be an adequate remedy for any such breach and that, in addition to any other rights and remedies existing hereunder, any party shall be entitled to specificperformance and/or other injunctive relief from any court of law or equity of competent jurisdiction (without posting any bond or other security) in order to enforce or prevent violation of the provisions of this Agreement. 

(c) Severability. Whenever possible, each provision of this Agreement shall be interpreted in such manner as to be effective andvalid under applicable law, but if any provision of this Agreement is held to be prohibited, invalid, illegal or unenforceable in any respect under any applicable law or regulation in any jurisdiction, such prohibition, invalidity, illegality orunenforceability shall not affect the validity, legality or enforceability of any other provision of this Agreement in such jurisdiction or in any other jurisdiction, but this Agreement shall be reformed, construed and enforced in such jurisdictionas if such prohibited, invalid, illegal or unenforceable provision had never been contained herein. 

 
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(d) Entire Agreement. Except as otherwise provided herein, this Agreement containsthe complete agreement and understanding among the parties hereto with respect to the subject matter hereof and supersedes and preempts any prior understandings, agreements or representations by or among the parties hereto, written or oral, whichmay have related to the subject matter hereof in any way, except as may be contained in the Purchase Agreement or the Warrants. 

(e) Successors and Assigns. Except as otherwise provided herein, this Agreement shall bind and inure to the benefit and beenforceable by the Company and its successors and assigns and the holders of Registrable Securities and their respective successors and permitted assigns (whether so expressed or not). In addition, whether or not any express assignment has beenmade, the provisions of this Agreement which are for the benefit of purchasers or holders of Registrable Securities are also for the benefit of, and enforceable by, any subsequent holder of Registrable Securities. 

(f) Notices. All notices, demands or other communications to be given or delivered under or by reason of the provisions of thisAgreement will be in writing and will be delivered personally, mailed by certified or registered mail, return receipt requested and postage prepaid, or sent by reputable overnight courier service (charges prepaid), to the recipient. Such notices,demands and other communications will be sent to the Company or the USH Investor specified below: 

**The Company:**

K-V Pharmaceutical Company 

One Corporate Woods Drive 

Bridgeton, MO 63044 

Attn: CEO 

Fax:314-646-3785 

With a copy to: 

Fried, Frank, Harris, Shriver and Jacobson LLP 

One New York Plaza 

New York, NY 10004 

Attention: Gary Kaplan, Esq. 

Facsimile: 212-859-4000 

**USH Investors:**

U.S. Healthcare I, L.L.C. 

c/o Kirkland & Ellis LLP 

601 Lexington Avenue 

New York, New York 10022 

Attn: Leonard Klingbaum, Esq. 

Fax: 212-446-6460 

 
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U.S. Healthcare II, L.L.C. 

c/o Kirkland & Ellis LLP 

601 Lexington Avenue 

New York, New York 10022 

Attn: Leonard Klingbaum, Esq. 

Fax: 212-446-6460 

or to such other address or to the attention of such other person as therecipient party has specified by prior written notice to the sending party. All such notices, demands or other communications will be deemed to have been given when actually received or refused by the recipient or when returned to the sender asundeliverable. 

(g) Business Days. If any time period for giving notice or taking action hereunder expires on a daythat is not a Business Day, the time period shall automatically be extended to the Business Day immediately following such Saturday, Sunday or legal holiday. 

(h) Governing Law. The corporation laws of the State of Delaware shall govern all issues concerning the relative rights of the Company and its stockholders. All other questions concerning theconstruction, validity, enforcement and interpretation of this Agreement shall be governed by the internal law of the State of New York, without giving effect to any choice of law or conflict of law provision or rule (whether of the State of NewYork or any other jurisdictions) that would cause the application of the laws of any jurisdictions other than the State of New York. 

(i) MUTUAL WAIVER OF JURY TRIAL. AS A SPECIFICALLY BARGAINED FOR INDUCEMENT FOR EACH OF THE PARTIES HERETO TO ENTER INTO THIS AGREEMENT (AFTER HAVING THE OPPORTUNITY TO CONSULT WITH COUNSEL), EACHPARTY HERETO EXPRESSLY WAIVES THE RIGHT TO TRIAL BY JURY IN ANY LAWSUIT OR PROCEEDING RELATING TO OR ARISING IN ANY WAY FROM THIS AGREEMENT OR THE MATTERS CONTEMPLATED HEREBY. 

(j) CONSENT TO JURISDICTION AND SERVICE OF PROCESS. EACH OF THE PARTIES IRREVOCABLY SUBMITS TO THE NON-EXCLUSIVE JURISDICTION OF THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF NEWYORK, FOR THE PURPOSES OF ANY SUIT, ACTION OR OTHER PROCEEDING ARISING OUT OF THIS AGREEMENT, ANY RELATED AGREEMENT OR ANY TRANSACTION CONTEMPLATED HEREBY OR THEREBY. EACH OF THE PARTIES HERETO FURTHER AGREES THAT SERVICE OF ANY PROCESS, SUMMONS,NOTICE OR DOCUMENT BY U.S. REGISTERED MAIL TO SUCH PARTY’S RESPECTIVE ADDRESS SET FORTH ABOVE SHALL BE EFFECTIVE SERVICE OF PROCESS FOR ANY ACTION, SUIT OR PROCEEDING WITH RESPECT TO ANY MATTERS TO WHICH IT HAS SUBMITTED TO JURISDICTION IN THISPARAGRAPH. EACH OF THE PARTIES HERETO IRREVOCABLY AND UNCONDITIONALLY WAIVES ANY OBJECTION TO THE LAYING OF VENUE OF ANY ACTION, SUIT OR PROCEEDING 

 
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ARISING OUT OF THIS AGREEMENT, ANY RELATED DOCUMENT OR THE TRANSACTIONS CONTEMPLATED HEREBY AND THEREBY IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF DELAWARE, AND HEREBY AND THEREBYFURTHER IRREVOCABLY AND UNCONDITIONALLY WAIVES AND AGREES NOT TO PLEAD OR CLAIM IN ANY SUCH COURT THAT ANY SUCH ACTION, SUIT OR PROCEEDING BROUGHT IN ANY SUCH COURT HAS BEEN BROUGHT IN AN INCONVENIENT FORUM. 

(k) No Recourse. Notwithstanding anything to the contrary in this Agreement, the Company and each holder of Registrable Securitiesagrees and acknowledges that no recourse under this Agreement or any documents or instruments delivered in connection with this Agreement, shall be had against any current or future director, officer, employee, general or limited partner or memberof any holder of Registrable Securities or of any Affiliate or assignee thereof, whether by the enforcement of any assessment or by any legal or equitable proceeding, or by virtue of any statute, regulation or other applicable law, it beingexpressly agreed and acknowledged that no personal liability whatsoever shall attach to, be imposed on or otherwise be incurred by any current or future officer, agent or employee of any holder of Registrable Securities or any current or futuremember of any holder of Registrable Securities or any current or future director, officer, employee, partner or member of any holder of Registrable Securities or of any Affiliate or assignee thereof, as such for any obligation of any holder ofRegistrable Securities under this Agreement or any documents or instruments delivered in connection with this Agreement for any claim based on, in respect of or by reason of such obligations or their creation. 

(1) Descriptive Headings; Interpretation. The descriptive headings of this Agreement are inserted for convenience only and do notconstitute a part of this Agreement. The use of the word “including” in this Agreement shall be by way of example rather than by limitation. 

(m) No Strict Construction. The language used in this Agreement shall be deemed to be the language chosen by the parties hereto to express their mutual intent, and no rule of strict constructionshall be applied against any party. 

(n) Counterparts. This Agreement may be executed in multiple counterparts, any oneof which need not contain the signature of more than one party, but all such counterparts taken together shall constitute one and the same agreement. 

(o) Electronic Delivery. This Agreement, the agreements referred to herein, and each other agreement or instrument entered into in connection herewith or therewith or contemplated hereby orthereby, and any amendments hereto or thereto, to the extent executed and delivered by means of a photographic, photostatic, facsimile or similar reproduction of such signed writing using a facsimile machine or electronic mail shall be treated inall manner and respects as an original agreement or instrument and shall be considered to have the same binding legal effect as if it were the original signed version thereof delivered in person. At the request of any party hereto or to any suchagreement or instrument, each other party hereto or thereto shall re-execute original forms thereof and deliver them to all other parties. No party hereto or to any such agreement or instrument shall raise the use of a facsimile machine orelectronic mail to 

 
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deliver a signature or the fact that any signature or agreement or instrument was transmitted or communicated through the use of a facsimile machine or electronic mail as a defense to theformation or enforceability of a contract and each such party forever waives any such defense. 

(p) Further Assurances.In connection with this Agreement and the transactions contemplated hereby, each holder of Registrable Securities shall execute and deliver any additional documents and instruments and perform any additional acts that may be necessary or appropriateto effectuate and perform the provisions of this Agreement and the transactions contemplated hereby. 

(q) No InconsistentAgreements. The Company shall not hereafter enter into any agreement with respect to its securities which is inconsistent with or violates the rights granted to the holders of Registrable Securities in this Agreement. 

(r) Confidentiality. Unless otherwise consented to by the Company, no holder may use any confidential information received by itpursuant to this Agreement (including notices of a Suspension Period) hereof) in violation of the Exchange Act other applicable state or federal securities law or reproduce, disclose, or disseminate such information to any other person (other thanhis or her attorneys, agents and representatives having a need to know, and then only if they expressly agree to be bound hereby), unless such information has been made available to the public generally (other than by such recipient in violationhereof) or such recipient is required to disclose such information by a governmental body or regulatory agency or by law in connection with a transaction that is not otherwise prohibited hereby, and then only after reasonable notice to the Companyand it has been provided an opportunity to object to such disclosure, with the reasonable cooperation and assistance of such holder. 

*    *    *    *    * 

 
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IN WITNESS WHEREOF, the parties have executed this Registration Rights Agreement as of thedate first written above. 

 
**U.S. Healthcare I, L.L.C.**By: