Page 45 - Appendices for Raquelle Myers
P. 45
!"#$%&
'
(0
4568 69 6:6
\"&$%
(b/.cdef2dgh,.,-2i(
)7.kc)k.,,)k.,,)7k.),.,,2,)c,..3-)2,.2c)72.1),.,,,3)772.3
)*+*,-.-/)12-.23)713.27)12-.23)713.27)12-.23;<=>?@@ABCDEFDGHIJKLMNONPJIQRKLMSTIUKTVWUNTN &a%%^`&a%%-1)2.1,2)7k.22)2.1,.-2)*2.37.3-)2,,.3-)/,.k7)/.**,7)1-/./-
XY Z5[[]"&^_`$&_"^`$&_"^)*.22)7k.2)*./,/7)13,.3-)2,,-)*,/.2k),.c21)-**.
l[m
2f
5 f ([n55,.2f,.2(
p
/,[6([(
l
k.cf[[
o (
l[
hf[0 [
[k,[6()k.-)/*1,Y
()2, (
)k,)/)*+23
0(66
(j[
0(6
(
([[*,-b3,[
(
(
)7k.22)7k.22*),.,,73.2,)/73.,.3-)2,,3.2c)k,3.**),.,,,.-*)*+21-.
d
For the last five months of
2020, your co-payments for
your drugs at Olympic
Pharmacy will be $$3,942.34
and your premiums will be
$110.50. Your total costs,
then, will be $4,034.84.
