$198$118.80
- $134$56.40Prescription eligible$134$64.20Prescription eligible
- $248$133.80$129$54Prescription eligible$129$61.80Prescription eligible
- $170Prescription eligible$578$277.20Prescription eligible$378$181.20Prescription eligible
- $438$184.20Prescription eligible$156$75Prescription eligible$217$91.20Prescription eligible
- $393
- $195Prescription eligible$195Prescription eligible$322$174Prescription eligible
- $367$198Prescription eligible$582$314.40Prescription eligible$133$79.80Prescription eligible
- $588$317.40Prescription eligible$248$133.80Prescription eligible$219$118.20Prescription eligible
- $308$166.20Prescription eligible$219$105Prescription eligible$176$52.80Prescription eligible
- $185$100.20$181$97.80$262$141.60
- $668$360.60$163$88.20Prescription eligible$163$97.80Prescription eligible
- $163$88.20Prescription eligible$158$94.80Prescription eligible$163$78Prescription eligible







































































