$322$174Prescription eligible
- $267$144Prescription eligible$106$95Prescription eligible
- $216$116.40Prescription eligible$288$121.20Prescription eligible$350Prescription eligible
- $144$86.40Prescription eligible$106$29Prescription eligible$231
- $108$97Prescription eligible$298$107.40
- $191Prescription eligible$191Prescription eligible$106Prescription eligible
- $282Prescription eligible$126$113Prescription eligible$239
- $108Prescription eligible
- $289$108$29Prescription eligible
- $108$29Prescription eligible

















































