Page 99 - Appendices for Eric Hartman
P. 99
ESTIMATED TOTAL MONTHLY DRUG COST
CVS Pharmacy Walgreens #12140 Mail Order
#09373 Pharmacy
Out-of-network
Preferred Preferred
January $8.26 $317.04 $20.01
February $6.00 $198.17 -
March $8.26 $317.04 -
April $6.00 $198.17 $20.01
May $8.26 $317.04 -
June $6.00 $198.17 -
July $8.26 $317.04 $20.01
August $6.00 $198.17 -
September $8.26 $317.04 -
October $6.00 $198.17 $20.01
November $8.26 $317.04 -
December $6.00 $198.17 -
