$198$118.80
- $248$89.40$218$117.60Prescription eligible
- $578$312Prescription eligible$196$105.60Prescription eligible$217$104.40Prescription eligible
- $195Prescription eligible$441$211.80Prescription eligible$367$198Prescription eligible
- $260$140.40Prescription eligible$582$314.40Prescription eligible$133$79.80Prescription eligible
- $588$317.40Prescription eligible$308$166.20Prescription eligible$413$198Prescription eligible
- $322$174Prescription eligible$125$60Prescription eligible$678$366
- $163$88.20Prescription eligible$163$78Prescription eligible$158$75.60Prescription eligible
- $158$85.20Prescription eligible$163$78Prescription eligible$517$248.40Prescription eligible
- $237$127.80Prescription eligible$591$283.80Prescription eligible$217$104.40Prescription eligible
- $216$116.40Prescription eligible$246$118.20Prescription eligible$495$237.60Prescription eligible
- $109$58.80Prescription eligible$163$88.20Prescription eligible$98Prescription eligible
- $237$114Prescription eligible$218$130.80Prescription eligible$245$103.20Prescription eligible







































































