Page 71 - APPENDICES for Vic Bosiger
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ESTIMATED TOTAL MONTHLY DRUG COST
CVS Pharmacy #07948
Preferred Preferred in-network pharmacy
January $229.90
February $229.90
March $479.84
April $452.49
May $452.49
June $452.49
July $198.56
August $123.85
September $123.85
October $123.85
November $123.85
December $123.85
ESTIMATED DRUG COSTS DURING COVERAGE PHASES
