Page 141 - Cover Letter and Evaluation for Gary Janke

10/8/2018 Your Medicare Health Plan Details
MEDICINE NAME QUANTITY FREQUENCY & GENERIC OPTIONS ACTION
PHARMACY
Change dose Add
SYMBICORT AER 160-4.5 1 X 10.2GM Every 1 Month Generic Not Remove
Inhaler Retail Available
Pharmacy

Change dose Add
VALSARTAN/HYDROCHLOROTHIAZIDE TAB 60 Every 1 Month Already Generic Remove
160-12.5
Retail
Pharmacy

Change dose Add
VENTOLIN HFA AER 1 X 18GM Every 12 Generic Not Remove
Inhaler Months Available
Retail
Pharmacy

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