Page 83 - APPENDICES for Diane Falten
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ESTIMATED TOTAL MONTHLY DRUG COST
CVS Pharmacy #10463
Preferred Preferred in-network pharmacy
January $21.49
February $21.49
March $21.49
April $21.49
May $21.49
June $21.49
July $21.49
August $21.49
September $21.49
October $21.49
November $21.49
December $21.49
ESTIMATED DRUG COSTS DURING COVERAGE PHASES
