$605$217.80
- $333$109Prescription eligible
- $908$490.20Prescription eligible$511Prescription eligible$333
- $486$122$73.20Prescription eligible$122$73.20Prescription eligible
- $138$82.80Prescription eligible$76$45.60Prescription eligible$422$253.20Prescription eligible
- $399Prescription eligible$452Prescription eligible$427Prescription eligible
- $512$256Prescription eligible$286$137.40Prescription eligible$452$217.20Prescription eligible
- $424$229.20Prescription eligible$286$171.60Prescription eligible$114$91Prescription eligible
- $114$91Prescription eligible$114$91Prescription eligible$118$94Prescription eligible
- $114$91Prescription eligible$128$61.20$128$76.80Prescription eligible
- $244$132$118$63.60Prescription eligible$488$263.40
- $298$107.40$388$232.80Prescription eligible$204$110.40
- $98Prescription eligible$418$250.80Prescription eligible$498$298.80Prescription eligible







































































