Page 63 - APPENDICES for Diane Falten
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ESTIMATED TOTAL MONTHLY DRUG COST
CVS Pharmacy #10463
Preferred Preferred in-network pharmacy
January $18.80
February $18.80
March $18.80
April $18.80
May $18.80
June $18.80
July $18.80
August $18.80
September $18.80
October $18.80
November $18.80
December $18.80
ESTIMATED DRUG COSTS DURING COVERAGE PHASES
