$176$105.60Prescription eligible
- $106$95Prescription eligible$589$318Prescription eligible
- $322$174Prescription eligible$648$310.80Prescription eligible$108$97Prescription eligible
- $478$258Prescription eligible$324$194.40Prescription eligible$194$105
- $202$97.20$202$121.20$228$123
- $822$444$163$88.20Prescription eligible$158$75.60
- $158$85.20Prescription eligible$163$78Prescription eligible$163$88.20Prescription eligible
- $163$88.20Prescription eligible$158$75.60Prescription eligible$163$78Prescription eligible
- $158$85.20$158$85.20$163$88.20
- $163$88.20Prescription eligible$163$88.20Prescription eligible$158$75.60Prescription eligible
- $163$88.20Prescription eligible$163$88.20Prescription eligible$163$88.20
- $163$88.20$145$78.60Prescription eligible$267$144Prescription eligible
- $178Prescription eligible$109$58.80Prescription eligible$108$64.80Prescription eligible







































































